创伤后应激障碍诊治研究新进展

创伤后应激障碍(PTSD)是创伤暴露事件中最常见的严重心理应激后果。有研究表明,超过70%的成年人都会经历其人生中各阶段的创伤事件;人一生中PTSD发生率为1.3%～12.2%。PTSD作为独立病种,其诊断和治疗方案不断变化。以美国《精神疾病诊断与统计手册》《国际疾病分类》(ICD)中的诊断标准为依据,本文对当前PTSD诊断、早期心理干预、药物治疗以及创新技术应用等方面的研究进行综述,以期为PTSD的预防、诊断及治疗提供参考。     

儿童创伤后应激障碍与自我意识、社会支持的关系研究

目的 通过对儿童创伤后应激障碍与自我意识、社会支持的关系研究,为开展灾区儿童PTSD患者干预或治疗提供依据和支持.方法 用创伤后应激障碍17项筛查问卷（PCL-C）、儿童自我意识量表、社会支持评定量表在舟曲泥石流16个月后,对547名儿童的创伤后应激障碍情况进行了调查分析,并对其与儿童自我意识、社会支持的情况进行了相关研究.结果 儿童PTSD总分在性别和年级上存在显著差异（p＜0.05）,经过多重比较发现高年级症状总分都显著高于低年级儿童;儿童自我意识与PTSD为显著的负相关（r=-0.333,p＜0.05）;社会支持与PTSD之间有显著的负相关（r=-0.099,p＜0.05）.结论 舟曲儿童创伤后应激障碍总体情况较严重;儿童自我意识可以直接预测PTSD的发生,社会支持可通过自我意识间接预测PTSD.     

消防应急救援队员创伤后应激障碍影响因素研究进展

中国消防职业化改革的新形势下,应急救援队员创伤后应激障碍（PTSD）研究面临新发展。本文结合国内外文献的一些理论研究与实践成果,对应急救援队员PTSD的社会心理因素等研究成果进行了综述,并对未来我国相关领域的研究与政策制定进行了建议与展望。     

苯二氮类治疗早期创伤残疾

创伤后应激障碍（PTSD）常表现为焦虚样症候，约占创伤残疾中的15％～25％。创伤残疾者在创伤后1周约有94％以上出现PTSD症状，然而这些症状的分布和严重程度，大多在9个月内缓解或稳定下来，较少演变为慢性残疾。精神药物中的很多种类被用于PTSD，使部分病情得到改善。但尚无对这些未发展为慢性残疾的病人进行过系统的研究。从理论角度来看，早期治疗也许有较好的效果，可以减少慢性PTSD的发生。调查提示，早期采用精神抖的处理，可以减少创伤残疾中PTSD的发生率和严重程度。在精神药物中，人们对苯二氮■类最有兴趣，可减少对记忆…     

胚胎停育患者创伤后应激症状及相关因素分析

目的:了解胚胎停育患者的心理损伤情况和创伤后应激障碍(PTSD)症状阳性的相关因素。方法:对2012年10月~2013年10月就诊于宁夏医科大学总医院、银川市妇幼保健院的206对胚胎停育患者及配偶,应用创伤后应激障碍筛查量表平民版(PCL-C)对其反复创伤性体验症状、情感麻木与回避状及警觉性过强所致易激惹症状进行客观测量。结果:206名胚胎停育患者PCL-C量表分值为23.7±2.7分,PTSD筛查症状阳性率为13.6%(28/206)。多因素非条件logistic回归分析结果显示,配偶PTSD症状筛查阳性时,胚胎停育患者PTSD症状阳性率高(OR:2.9,95%CI:1.8~9.7),社会支持中从兄弟姐妹得到支持和照顾时,胚胎停育患者PTSD症状阳性率低(OR:0.5,95%CI:0.3~0.9)。结论:胚胎停育事件可能会引起孕妇产生创伤后应激障碍症状。配偶PTSD症状阳性会增加胚胎停育孕妇PTSD症状阳性率,而社会支持,尤其是从兄弟姐妹得到支持和照顾,有助于缓解胚胎停育孕妇PTSD症状。     

地震极重灾区小学教师的创伤后应激障碍调查

目的了解地震极重灾区小学教师1年后的创伤后应激障碍(post-traumatic stress disorder,PTSD)的程度。方法用创伤后应激障碍自评量表(PTSD-SS)和暴露情况调查表对188名青川县小学教师进行测评。结果 71.2%的教师存在PTSD症状,男女教师之间的差异有统计学意义(P0.05);亲友死亡是导致PTSD的重要原因。结论地震极重灾区小学教师,尤其是男性教师,存在严重的慢性PTSD。     

创伤后应激障碍对青少年偏差行为的影响

青少年出现偏差行为的现象在社会中普遍存在,对社会造成不良影响。遭受创伤应激事件并患有创伤后应激障碍(post-traumatic stress disorder,PTSD)的青少年出现偏差行为的风险显著高于普通同龄群体,并且其个人生活受到一定程度的负面影响。对青少年患有PTSD对偏差行为的影响研究结果进行综述,主要将青少年偏差行为分为伤害性行为、偏畸习癖和学业适应问题。同时探讨创伤后应激障碍影响青少年偏差行为的神经机制,并为偏差行为的矫正干预提供建议。     

中青年急性心肌梗死患者创伤后应激障碍症状群变化轨迹及其影响因素

目的 了解中青年急性心肌梗死(acute myocardial infarction, AMI)患者术后的创伤后应激障碍(post-traumatic stress disorder, PTSD)情况及PTSD症状群变化轨迹,分析其影响因素,以指导临床干预患者形成良好康复行为。方法 采用一般资料调查表、创伤后应激障碍症状问卷中文平民版(PCL-C)、综合性医院焦虑抑郁量表(HADS),对280例中青年急性心肌梗死患者术后3天及出院后3个月、6个月、12个月的心理状态进行随访,基于收集的数据分别构建线性增长曲线模型及不定义增长曲线模型,分析患者创伤后应激障碍症状群的变化轨迹及影响因素。结果 111例患者被诊断为PTSD,PTSD阳性率为39.64%,其中106例患者完成全程随访,中青年AMI患者术后PTSD的再体验、回避、情感麻木、高警觉症状群均呈非线性下降趋势(P<0.05)。协变量分析结果显示：女性、存在并发症、术中知晓程度低的患者,PTSD初始水平高(P<0.05);术中知晓程度高的患者,PTSD症状改善快(P<0.05)。不同时期的抑郁、焦虑水平对相应时期的PT...     

创伤后应激障碍的流行和预测研究进展

创伤后应激障碍(Postraumatic stress disorder,PTSD)是经历创伤性事件后特异性的心理疾患之一。自1980年美国精神疾病诊断与统计手册第3版首次采用创伤后应激障碍这一诊断,逐渐在全球范围内引起广泛关注,但是对于创伤后应激障碍的早期预防和干预还存在不足。回顾创伤后应激障碍的流行情况、预测因素的研究进展,帮助心理工作者认识到创伤后应激障碍的发生情况和高危因素,采取积极的心理干预措施,减少创伤后应激障碍的发生。     

珠三角地区创伤患者睡眠障碍与PTSD关系

目的 了解珠江三角洲地区创伤住院患者创伤后应激障碍（PTSD）与睡眠障碍的发生情况及二者关系,并分析创伤后应激障碍患者睡眠障碍的影响因素。方法 采用目的抽样法抽取珠江三角洲地区708名创伤患者,使用PTSD平民版筛查问卷（PCL-C）、匹兹堡睡眠质量指数量表（PSQI）及自编影响因素调查表进行问卷调查。结果 珠江三角洲地区708名创伤患者PTSD发生率为27.5%,其中,轻或中度症状者占68.2%（133/195）,重度症状者占31.8%（62/195）;睡眠障碍的总发生率为37.9%,其中,无症状、轻度或中度、重度PTSD症状患者睡眠障碍发生率分别为27.9%（143/513）、57.9%（77/133）、77.4%（48/62）;无PTSD症状的513人中,PSQI均分为（6.79±3.78）分,睡眠障碍143人;轻度或中度PTSD症状的133人中,PSQI均分为（6.62±3.69）分,睡眠障碍77人;重度PTSD症状的62人中,PSQI均分为（7.26±3.72）分,睡眠障碍48人;PTSD自评量表PCL-C得分与PSQI得分呈正相关（r=0.480,P<0.05）;不同程度的PTSD患者的睡眠总体情况及7个睡眠因子差异均有统计学意义（P<0.001）;多因素分析表明,PTSD患者睡眠障碍的主要影响因素为距事故发生时间（OR=1.303,95%CI=1.129~1.503）、脊柱受伤（OR=1.991,95%CI=1.219~3.251）和生活自理程度（OR=1.684,95%CI=1.286~2.206）。结论 PTSD患者的睡眠障碍随PTSD加剧而加重,不同程度的PTSD患者的睡眠障碍表现不同,主要受距事故发生时间,脊柱受伤与否及生活自理程度的影响。     

The relationship between quality of life and posttraumatic stress disorder or major depression for firefighters in Kaohsiung,Taiwan

Objective The work of firefighters involves the risk of exposure to the harmful effects of toxic substances as well as the possibility of enormous emotional shock from disasters, which may result in psychiatric impairments and a lower quality of life. Therefore, we examined quality of life, prevalence of posttraumatic stress disorder (PTSD) and major depression, and the related risk factors for firefighters in Kaohsiung, Taiwan. Methods This is a two-stage survey study. During the first stage, we used the 36-item Short-Form Health Survey (SF-36) and the Disaster-Related Psychological Screening Test (DRPST) to assess quality of life, probable PTSD, probable major depression, and the related risk factors for 410 firefighters. During the second stage, psychiatrists categorized these probable cases according to self-reported questionnaires against DSM-IV into PTSD or major depression group, subclinical group, and health group. All the data were analyzed with SPSS 10.0 Chinese version. Results The estimated current prevalence rates for major depression and PTSD were 5.4% (22/410) and 10.5% (43/410), respectively. The firefighters with estimated PTSD or major depression scored significantly lower on quality of life measures than subclinical PTSD/major depression and mentally healthy groups, which was evident in eight concepts and two domains of the SF-36. The major predictors of poor quality of life and PTSD/major depression were mental status, psychosocial stressors, or perceived physical condition. Conclusion Firefighters have a higher estimated rate of PTSD, and the risk factors that affect quality of life and PTSD/major depression should encourage intervention from mental health professionals.     

Combat stress reactions, posttraumatic stress disorder, cumulative life stress, and physical health among Israeli veterans twenty years after exposure to combat

This study examined the association of initial combat stress reaction (CSR), chronic post-traumatic stress disorder (PTSD) and cumulative life stress on physical health 20 years after the 1982 war with Lebanon, in a sample of 504 Israeli veterans of the war. Two groups were assessed: male veterans who fought and suffered from CSR and a matched group of male veterans from the same units who did not exhibit such reactions. Twenty years following the war, participants were asked to rate their general physical health status, report health complaints and risk behaviors, and were screened for PTSD. CSR and, to a greater extent, PTSD, were found to be associated with general self-rated health, chronic diseases and physical symptoms, and greater engagement in risk behaviors. CSR and PTSD were also related to greater cumulative life stress since the war. Both negative and positive life events were independently related to most of the physical health measures but did not account for the associations of CSR and PTSD with poorer health. Tests of the interactions between CSR, PTSD and life stress in their association with physical health and risk behaviors showed that PTSD suppressed the effects of additional life stress (negative life events had a weaker effect on health among participants with PTSD).     

Posttraumatic stress disorder in Manhattan,New York City,after the September 11th terrorist attacks

Estimates of acute mental health symptoms in the general population after disasters are scarce. We assessed the prevalence and correlates of acute posttraumatic stress disorder (PTSD) in residents of Manhattan 5–8 weeks after the terrorist attacks of September 11, 2001. We used random-digit dialing to contact a representative sample of adults living in Manhattan below 110th Street. Participants were interviewed about prior life events, personal characteristics, exposure to the events of September 11th, and psychological symptoms after the attack. Among 988 eligible adults, 19.3% reported symptoms consistent with PTSD at some point in their life, and 8.8% reported symptoms consistent with a diagnosis of current (within the past 30 days) PTSD. Overall, 57.8% of respondents reported at least one PTSD symptom in the past month. The most common past-month symptoms were intrusive memories (27.4%) and insomnia (24.5%). Predictors of current PTSD in a multivariable model were residence below Canal Street, low social support, life stressors 12 months prior to September 11th, perievent panic attack, losing possessions in the attacks, and involvement in the rescue efforts. These findings can help guide resource planning for future disasters in densely populated urban areas.     

Examining a Comprehensive Model of Disaster-Related Posttraumatic Stress Disorder in Systematically Studied Survivors of 10 Disasters

Objectives. Using a comprehensive disaster model, we examined predictors of posttraumatic stress disorder (PTSD) in combined data from 10 different disasters.Methods. The combined sample included data from 811 directly exposed survivors of 10 disasters between 1987 and 1995. We used consistent methods across all 10 disaster samples, including full diagnostic assessment.Results. In multivariate analyses, predictors of PTSD were female gender, younger age, Hispanic ethnicity, less education, ever-married status, predisaster psychopathology, disaster injury, and witnessing injury or death; exposure through death or injury to friends or family members and witnessing the disaster aftermath did not confer additional PTSD risk. Intentionally caused disasters associated with PTSD in bivariate analysis did not independently predict PTSD in multivariate analysis. Avoidance and numbing symptoms represented a PTSD marker.Conclusions. Despite confirming some previous research findings, we found no associations between PTSD and disaster typology. Prospective research is needed to determine whether early avoidance and numbing symptoms identify individuals likely to develop PTSD later. Our findings may help identify at-risk populations for treatment research.The frequency of major disasters in the United States alone is staggeringly high: once a week on average, a new disaster strikes somewhere in the United States.1 Considering the frequency and devastation caused by such events in the United States and worldwide, understanding the psychiatric sequelae of major disasters is a public health issue of paramount importance.A comprehensive model, developed by this research team, of the mental health outcomes of disaster provides a framework for understanding factors associated with mental health sequelae of disasters.2 This model includes domains of personal characteristics of survivors, characteristics of the disaster agent and individual exposures to it, characteristics of the disaster community, and secondary sequelae and other negative life events. Few studies, however, are designed to assess the relative contribution of these different factors, and comparison of the prevalence of psychiatric disorders among survivors of different disasters has been hampered by lack of diagnostic rigor and inconsistent methods across studies.A landmark review by Norris et al.3,4 compiled mental health outcome data across the domains of the comprehensive model in a careful synthesis of 20 years of disaster research. This review included 250 published articles on the combined experience of 61 396 disaster survivors from 102 disasters. The body of original research reviewed was conducted in separate studies of numerous disasters by many research teams using “a variety of designs, time frames, assessment strategies, and sampling methods.”3(p240) Although Norris’s group noted widely held assumptions that human-caused disasters result in more severe mental health sequelae compared with natural disasters, they urged further consideration of these relationships.4 They also identified a continuing need for research that is prospective and longitudinal and examines diverse populations whose exposure is sufficient to yield adverse mental health consequences.The inherently emergent and chaotic nature of the postdisaster setting presents barriers to methodological rigor in disaster research. These conditions hamper timely access to highly exposed survivors, impede systematic sampling, restrict sample sizes, and limit time and resources that are critical to conducting full diagnostic assessments, and they undoubtedly contribute to contradictory findings in disaster research. Comparison of disaster research findings is limited by the variability in types and severity of disasters (e.g., large-scale vs more limited, local disasters; terrorism vs natural disasters), diversity of research samples (e.g., highly exposed survivors vs people who were distant from the incident; general population members vs treatment samples), and breadth of research methods (e.g., full diagnostic assessment vs questionnaires and symptom scales) inherent in this body of research.To overcome these limitations in understanding the psychosocial effects of disasters, comprehensive studies are needed that examine a breadth of disasters and exposed populations and use consistent methods. In the largest cross-disaster study conducted to date using consistent methods (uniform assessments and time frames) with full diagnostic evaluation, we merged data from 811 directly exposed survivors of 10 disasters of various types, conducted by 1 disaster team, to provide systematic data on the prevalence of posttraumatic stress disorder (PTSD) and its predictors.     

Prediction of posttraumatic stress disorder among adults in flood district

Background  

Flood is one of the most common and severe forms of natural disasters. Posttraumatic stress disorder (PTSD) is a common disorder among victims of various disasters including flood. Early prediction for PTSD could benefit the prevention and treatment of PTSD. This study aimed to establish a prediction model for the occurrence of PTSD among adults in flood districts.     

An Unusual Clinical Presentation of Posttraumatic Stress Disorder in a Sudanese Refugee

Some anxiety disorders may present with signs and symptoms that may linger many years after the stress-inducer events and threat has passed. A case of posttraumatic stress disorder is presented in this report of a Sudanese refugee presenting with chronic abdominal and lower back pain. PTSD in refugees may present with typical or atypical manifestations such as chronic pain syndromes. Therefore, the identification by medical providers of the spectrum of signs and symptoms compatible with PTSD is critical. We suggest that the diagnosis of PTSD requires a culture-based approach in the clinical history-taking incorporating geopolitical context and an in-depth assessment of the degree of exposure to serial traumatic events.     

The predictive value of post-traumatic stress disorder symptoms for quality of life: a longitudinal study of physically injured victims of non-domestic violence

Background  

Little is known about longitudinal associations between post-traumatic stress disorder (PTSD) and quality of life (QoL) after exposure to violence. The aims of the current study were to examine quality of life (QoL) and the predictive value of post-traumatic stress disorder (PTSD) for QoL in victims of non-domestic violence over a period of 12 months.     

便携式生命支持系统的研制

目的设计一种便携式生命支持系统,该系统是为院前重症患者转运所研发的小型综合急救系统。方法结合内嵌设备结构及急救器材与药品的配置特点,系统设计主要包括机械通气、输液、吸引、监护、供氧、供电等模块。采用了先进的计算机辅助设计软件,对系统框架整体结构、设备安放位置、固定方法、干涉情况、操作性能等进行仿真设计。结果该系统可与通用担架进行快速卡锁形成便携式重症监护病房（ICU）,可以搭载多种交通工具,并能利用车载电源,在运送途中对患者实施不间断治疗和救护,提高了抢救成功率。结论本文研制的便携式生命支持系统外型小巧,重量轻,便携性强,功能齐全,操作方便,为院前重症患者转运过程中不间断急救复苏,提供了一种新型的综合急救装备。     

The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity

In this paper the experiences of the chronically ill are examined to explore the impact of post-traumatic stress disorder (PTSD), accumulated burden of adversity and trauma spectrum disorder on subsequent illness and coping behaviors. Individuals experiencing chronic diseases have been studied with regard to depression, anxiety and a variety of coping maladaptions, but negligible attention has been given to the PTSD potential of chronic disease over the life course. Yet, growing evidence suggests that the traumatogenic potential of chronic diseases, some sudden and unexpected onsets, and the traumatogenic changes in life circumstance, may produce maladaptive illness coping over the life course. More importantly, attention needs to focus on the additive effect of co-morbid life events and the traumatic potential of invasive medical therapies. Consideration of PTSD and a continuum of cumulative adversity provide a more complex and fully drawn understanding of the circumstances surrounding chronic illness coping and reasons for maladaptive coping following invasive therapies and changes in the disease trajectory. The pathophysiology that produces a chronic diseases does not begin at symptom onset, and the psychosocial strategies to cope with a chronic illness, whether efficacious or maladaptive, also do not begin at symptom onset, but develops over the life course.     

Use of Guideline-Recommended Treatments for PTSD Among Community-Based Providers in Texas and Vermont: Implications for the Veterans Choice Program

Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by the Department of Veterans Affairs (VA) in community settings. However, the quality of that care is unknown, particularly for complex conditions such as posttraumatic stress disorder (PTSD). A cross-sectional survey was conducted of 668 community primary care and mental health providers in Texas and Vermont to describe use of guideline-recommended treatments (GRTs) for PTSD. Relatively, few providers reported using guideline-recommended psychotherapy or prescribing practices. More than half of psychotherapists reported the use of at least one guideline-recommended psychotherapy for PTSD, but fewer reported the use of core treatment components, prior training in the GRT(s) they use, or adherence to a treatment manual. Suboptimal prescribing for PTSD patients was reported more commonly than optimal prescribing. Findings raise critical questions regarding how to ensure veterans seeking PTSD care in community settings receive psychotherapy and/or prescribing consistent with clinical practice guidelines.