创伤后应激障碍患者脑结构的磁共振研究

目的探讨创伤后应激障碍（PTSD）患者是否存在大脑结构形态学的改变。方法对12例因火灾事故而致PTSD患者（PTSD组）、12名年龄、性别和创伤暴露均与PTSD组相匹配的正常人（对照组）进行MRI扫描，获取脑结构的T1加权像和3维图像，进行基于像素的形态测量学分析，比较两组灰质、白质密度的异同。结果在控制了年龄和性别的影响后，PTSD组与对照组灰质密度比较的差值，在左侧海马（Talairaeh坐标：x=-26mm，y=-13Inln，z=-17mm，t=5．05）、左侧前扣带回（X=-2mm，y=40mm，z=17mm，t=5．06）和双侧岛叶（右侧岛叶x=34mm，y=4mm，z=6mm，t=4．64；左侧岛叶x=-34mm，y=4mm，z=6mm，t=4．44）的差异有统计学意义（P〈0．001）；两组在其他脑区灰质或白质密度的差异无统计学意义。结论创伤后应激障碍患者的海马、前扣带回和岛叶都有灰质密度的减少，提示这些脑区的结构存在病理性改变。     

矿难后急性重性创伤后应激障碍症状激发和创伤有关短期记忆提取的功能性磁共振成像研究

目的 探讨急性重性创伤后应激障碍(post traumatic stress disorder,PTSD)患者的脑功能及执行记忆功能时的脑反应.方法 采用功能磁共振成像技术,对经历矿难的10例急性重性PTSD患者(PTSD组)和7例非PTSD对照(非PTSD组)执行症状激发任务,并首次采用1项创伤有关的短期记忆提取任务...     

创伤后应激障碍中创伤记忆的研究进展

创伤后应激障碍(PTSD)是强烈精神创伤后发生的临床综合征。PTSD创伤记忆有其复杂性。本文对PTSD中创伤记忆的特点、创伤记忆重建以及认知神经科学的临床、动物实验研究现状进行综述。     

唐山大地震心理创伤后应激障碍的抽样调查研究

目的 调查唐山大地震心理创伤后应激障碍（ＰＩＳＤ）的患病率,方法 应用自行编制的ＰＩＳＤ调查表和标准化评定工具,对地震时在唐山市区居住且亲身经在地震者１８１３人进行抽样调查。结果 １８１３人中诊断为急性应激反应（ＡＳＲ）３３５例（１８．４８％）延迟性应激障碍（ＤＳＤ）４０２例（２２．１７％）其中现患ＤＳＤ１７例,现患率为０．９４％,结论 大地震后ＡＳＲ和ＤＳＤ的患病率高,个体远期心身健康水平较低。     

创伤后应激障碍及重复经颅磁刺激在其治疗中的研究进展

随着我国社会和经济的发展,人们的生活质量得到显著改善。但是各种天灾人祸仍层出不穷,如地震、火灾、矿难、空难以及车祸等,这些灾难给人们心理造成了不同程度的创伤,也在一定程度上导致了创伤后应激障碍（Post—traumatic Stress Disorder,PTSD）的发生。     

Emotional face processing in post-traumatic stress disorder after reconsolidation impairment using propranolol: A pilot fMRI study

Individuals with post-traumatic stress disorder (PTSD) exhibit exaggerated emotional reactions to threatening stimuli, which may represent deregulated fear-conditioning, associated with long-term adaptations in the sympathetic nervous system. Within a repeated measures design, functional magnetic resonance imaging (fMRI) was employed to investigate neural responses to threat in PTSD participants (N = 7), during the presentation of emotional facial expressions. Scans were separated by 6 weekly reconsolidation impairment treatment sessions, consisting of traumatic memory reactivation under the influence of propranolol. Greater activation before versus after treatment emerged in the thalamus and amygdala during fearful versus neutral face processing. Furthermore, participants showed greater activation after versus before treatment in the right anterior cingulate, during fearful relative to happy face processing. PTSD symptoms significantly improved (d = 1.75), post-treatment. These preliminary results suggest that aberrant emotional responding is modulated by noradrenergic plasticity within the amygdala-prefrontal cortex circuit, a neural substrate for the pharmacological treatment of PTSD.     

张北地震后应激障碍患者神经内分泌和细胞因子的研究

目的研究应激障碍患者血浆皮质醇、生长激素、泌乳素和白细胞介素(IL)2,6,8与正常个体的差异.方法于河北省张北尚义发生里氏6.2级地震后3个月,在当地选取因地震导致的创伤后应激障碍(PTSD)患者34例(PTSD组),未达到PTSD诊断标准且不符合其他精神障碍的受应激个体30例(非PTSD受应激组),未受应激者34名(对照组),进行血浆皮质醇、生长激素、泌乳素和白细胞介素(IL)2,6,8的检测.血浆皮质醇、生长激素、泌乳素、IL-2检测采用放射免疫法; IL-6和IL-8检测采用酶联免疫法.结果 PTSD组患者和非PTSD受应激组的血浆皮质醇浓度均明显高于对照组,差异有统计学意义(P=0.013,P=0.006);血浆IL-2浓度均明显低于对照组,差异均有统计学意义(P=0.000,P=0.000).三组间泌乳素及IL-6的差异无统计学意义(P=0.389,P=0.363).PTSD组的生长激素浓度与非PTSD受应激组(P=0.099)及对照组(P=0.511)的差异无统计学意义.非PTSD受应激组的生长激素浓度明显高于对照组(P=0.014).PTSD组患者IL-8浓度明显高于非PTSD受应激组 (P=0.021), 而与对照组的差异无统计学意义 (P=0.078).非PTSD受应激组IL-8浓度明显低于对照组(P=0.000).结论 PTSD患者的神经内分泌和免疫系统有异常改变.     

Volume of cerebellar vermis in monozygotic twins discordant for combat exposure: Lack of relationship to post-traumatic stress disorder

Several functional neuroimaging studies have implicated the cerebellar vermis in post-traumatic stress disorder (PTSD), but there have been no structural neuroimaging studies of this brain structure in PTSD. We utilized magnetic resonance imaging (MRI) with manual tracing to quantify the volumes of three divisions of the mid-sagittal vermis, and their total, within an identical, co-twin control design that employed Vietnam veterans discordant for combat exposure in Vietnam. Each structure's volume was significantly correlated between twins, indicating a partial familial determination: for anterior superior vermis, r = 0.73; for posterior superior vermis, r = 0.47; for inferior posterior vermis, r = 0.51; and for total vermis, r = 0.57. There were no significant differences between the PTSD and non-PTSD veterans for any vermis volume, and no significant main effects or interactions when their non-combat-exposed co-twins were added to the analyses. Thus, the results do not support the structural abnormality of cerebellar vermis in combat-related PTSD.     

地震后被转移伤员创伤后应激障碍及心理状况分析

目的 调查地震后被转移伤员创伤后应激障碍(PTSD)的发生及其心理健康状况.方法 采用PTSD症状自评和诊断工具及症状自评量表(SCL-90),在地震后40 d对354例被转移伤员的PTSD的发生和心理健康状况进行评估.结果 (1)地震后40 d,有82例(23.2%)伤员发生PTSD,女性55例(55/200,27.5%),男性27例(27/154,17.5%),女性发生率高于男性,差异有统计学意义(P＜0.05);在不符合PTSD诊断的伤员中,199例(199/249,79.9%)存在再体验症状,164例(164/249,65.9%)存在麻木或回避症状,208例(208/249,83.5%)存在过度唤起症状.(2)PTSD患者的SCL-90总分(209.00±68.78)分、强迫症状因子(2.38±0.61)分、人际关系敏感因子(2.18±0.87)分、抑郁因子(2.50±0.86)分、焦虑因子(2.42±0.90)分、敌对因子(2.47±0.87)分,高于非PTSD患者[(153.08±5.63)分、(1.71±0.64)分、(1.50±0.60)分、(1.71±0.69)分、(1.70±0.76)分、(1.66±0.73)分;P＜0.05,P＜0.01].(3)地震后被转移伤员的SCL-90总分、躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、偏执、精神病性和其他因子得分高于全国常模组(P＜0.05,P＜0.01).结论 地震后部分被转移伤员出现PTSD,相当多的伤员遭受了不同程度的心理影响,应予以长期关注.

Abstract：

Objective To investigate the incidence of post traumatic stress disorder ( PTSD ) and mental status in the transferred wounded after Wenchuan earthquake. Methods At the 40th day after earthquake, 354 wounded were evaluated by the PTSD Symptoms Self Rating Scale, and Symptom Checklist 90 ( SCL-90 ). The diagnosis of PTSD was made according to DSM-Ⅳ criteria. Results After 40 days, 82( 23.2% )suffered PTSD in these wounded, including 55 females( 55/200,27.5% ) and 27 males( 27/154,17. 5% ), the rate in women was significantly higher than that in men. In those non-PTSD wounded, 199patients 199/249,79.9% ) had re-experienced symptoms, 164 patients( 164/249,65.9% ) had numbness/escaping symptoms, 208 patients( 208/249,83.5% ) had excessive arousing symptoms. The SCL-90 total score( 209.00 ±68.78 ), obsession( 2. 38 ± 0. 61 ), human relation sensitivity( 2. 18 ± 0. 87 ), depression ( 2. 50 ±0. 86 ), anxiety( 2.42 ± 0. 90 ) and hostility factor( 2.47 ± 0. 87 ) score of the PTSD were higher than those of the non-PTSD[( 153.08 ± 5.63 ),( 1.71 ± 0. 64 ),( 1. 50 ± 0. 60 ),( 1.71 ± 0. 69 ),( 1.70 ±0. 76 ),( 1.66 ±0. 73 );P ＜0. 05 -0. 01] . The SCL-90 total score and somatization, obsession, depression,anxiety, hostility, phobia, crankiness, psychosis and the other factor score of the wounded were higher than those of the national norm group( P ＜ 0. 05 - 0. 01 ). Conclusion Considerable number of the transferred wounded existed PTSD symptoms in experienced earthquake disaster, they need to be intervened for a long period.     

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.     

创伤后应激障碍患者陈述性记忆损害与岛叶关系的磁共振成像研究

目的 利用功能磁共振成像(fMRI)技术,探讨在创伤后应激障碍(PTSD)患者的陈述性记忆损害中是否存在岛叶结构及功能异常.方法 应用基于体素的形态测量学和汉字编码任务,对12例PTSD患者(PTSD组)和12名正常对照者(对照组)进行脑结构和fMRI扫描,比较两组间岛叶结构及功能的差异.结果 (1)FTSD患者双侧岛叶的灰质密度(右侧岛叶x=34,y=4,x=6,t=4.44;左侧岛叶x=-36,y=2,z=0;t=4.64)低于对照组;(2)在编码作业时,左侧岛叶的激活程度(x=-40,y=-20,z=14)亦低于对照组(P均<0.05).结论 PTSD患者的岛叶存在结构损害,并在陈述性记忆作业中呈现功能异常,提示岛叶结构的损害可能与PTSD的陈述性记忆损害有关.     

汶川地震所致创伤后应激障碍患者的共病分析

目的:了解汶川地震部分极重灾区所致创伤后应激障碍(PTSD)患者共病其他精神障碍的情况,以及影响共病的因素。方法:采用方便取样,对四川省绵阳市所辖的安县、平武县及北川县部分受灾群众进行调查,以DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID-I/P)为诊断工具。结果:共138例诊断PTSD,其中90例共病其他精神障碍,共病率65.2%;42.8%患者共病重性抑郁障碍,12.3%共病特殊恐怖症,10.9%共病惊恐发作;40～59岁共病率最高为70.4%(χ2=5.94,P=0.05),有亲人死亡者共病抑郁症35例,明显高于无亲人死亡者24例,两者差异有统计学意义(χ2=4.16;P=0.04)。结论:65.2%PTSD患者共病其他精神障碍,以共病重性抑郁障碍、特殊恐怖症、惊恐发作最多见,共病率与年龄相关,地震中有亲人死亡将增加PTSD共病抑郁症风险。     

保定市创伤后应激障碍流行病学调查

目的：了解保定市18岁及以上人群创伤后应激障碍患病率。方法：采用多阶段分层整群抽样方法随机抽取10073名≥18岁的人群为调查对象，用扩展的一般健康问卷（GHQ-12）将调查对象分为高、中、低危险组，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）对调查对象进行DSM-Ⅳ修订版轴Ⅰ障碍定式临床用治疗提纲（SCID-I／P），对各类精神障碍进行诊断。结果：9021人完成调查。创伤后应激障碍时点患病率为3．7‰，终生患病率5．7‰。创伤后应激障碍时点患病者33例中6例（18．8％）患者与情感障碍共病。结论：创伤后应激障碍已成为严重影响社会、经济发展的因素之一，应列入防治和研究的重点疾病。     

Prevalence of post-traumatic stress disorder in incarcerated juvenile delinquents in Japan

The present study investigated frequency of post-traumatic stress disorder (PTSD) in incarcerated juvenile delinquents in Japan. The presence of overwhelming traumatic experiences, which fulfilled the DSM-IV criterion A for PTSD, was evaluated using a self-report questionnaire in 251 delinquents (206 males and 45 females). The structured interview using the Clinician-administered PTSD Scale for DSM-IV (CAPS) was administered to those with the experiences. A substantial portion (36%) of the delinquents reported experiences of exposure to such overwhelming traumatic events, which fulfilled the criterion A. Among those who met the criterion A, 48 subjects (40 males and eight females) received the CAPS interview. Ten (21%) out of 48 were diagnosed with current or past history of full PTSD. Three subjects out of the 10 were currently diagnosed with full PTSD. Another 10 subjects out of 48 (21%) had fulfilled the criteria for current or past history of partial PTSD. Among the 10, one was diagnosed as currently suffering from partial PTSD. In females, frequencies of the past history were quite high (50% for full PTSD and 25% for partial PTSD in the eight subjects), while none was currently diagnosed with PTSD.     

Longitudinal course of salivary cortisol in post-traumatic stress disorder

OBJECTIVE: In chronic post-traumatic stress disorder (PTSD) lowered cortisol secretion and hypersuppression to dexamethasone has been described repeatedly. However, so far no longitudinal data on the natural course or on the effect of therapy are available. METHOD: We measured basal and post-dexamethasone morning salivary cortisol in a drug-free patient with chronic PTSD (DSM-IV) monthly for nearly 2 years and assessed PTSD and depressive symptoms. RESULTS: Salivary cortisol decreased dramatically 3 months after the traumatic event and in the further course showed an inverse relation to fluctuating but gradually improving PTSD symptoms. Post-dexa-methasone cortisol was suppressed below the detection limit early after trauma and rose again more than 1 year post-trauma. CONCLUSION: Both the potential renormalization of low cortisol levels in improving chronic PTSD and the putative vulnerability to develop PTSD in subjects with increased dexamethasone suppression need further research.