地震现场救援军人吸烟与创伤后应激障碍的相关性

目的:了解吸烟与创伤暴露、创伤后应激障碍(PTSD)之间的关系.方法:共1 125名地震现场救援军人在四川汶川地震6个月后纳入调查.调查工具包括一般人口学资料、Davidson创伤量表(DTS)及烟草依赖情况调查表.结果:实查1 056人,共检出PTSD患者69例,PTSD患病率6.53%.调查发现:①PTSD组吸烟率...     

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.     

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

Objective To determine the prevalence of post-traumatic stress disorder (PTSD) and its impact factors 6 months after Wenchuan earthquake in a group of military first responders.Method A total of 1125 military first responders serving in the earthquake were screened and enrolled in the study.The social-demographic characteristics, Davidson Trauma Scale ( DTS), earthquake exposure screening scale, Beck Anxiety Inventory (BAI) and Beck Depression Inventory ( BDI- Ⅱ ) were assessed to every first responder 6 months after the earthquake.The PTSD diagnosis was based on both DTS ≥ 40 and DSM-Ⅳ criteria.Results The final analysis was carried out on 1056 first responders.The prevalence of PTSD was 6.53% (69 cases) according to DTS criteria and 5.97% (63 cases) according to DSM-Ⅳ criteria.The univariate analysis revealed that being a single child, dissatisfied with current service, having a history of smoking or drinking, no psycho counseling during traumatic exposure and intensity of traumatic exposure were significantly associated with an increased risk of PTSD.Results from logistic regression indicated that the intensity of traumatic exposure, no psycho counseling during traumatic exposure were significant predictors of PTSD.Being a single child (OR =2.24, 95% CI 0.98 -5.12,P =0.057) was a trend predictor of PTSD.Conclusion The study results support that PTSD is a common mental disorder in military first responders earthquake, it is necessary to strengthen psychological protection and crisis intervention.     

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

Objective To determine the prevalence of post-traumatic stress disorder (PTSD) and its impact factors 6 months after Wenchuan earthquake in a group of military first responders.Method A total of 1125 military first responders serving in the earthquake were screened and enrolled in the study.The social-demographic characteristics, Davidson Trauma Scale ( DTS), earthquake exposure screening scale, Beck Anxiety Inventory (BAI) and Beck Depression Inventory ( BDI- Ⅱ ) were assessed to every first responder 6 months after the earthquake.The PTSD diagnosis was based on both DTS ≥ 40 and DSM-Ⅳ criteria.Results The final analysis was carried out on 1056 first responders.The prevalence of PTSD was 6.53% (69 cases) according to DTS criteria and 5.97% (63 cases) according to DSM-Ⅳ criteria.The univariate analysis revealed that being a single child, dissatisfied with current service, having a history of smoking or drinking, no psycho counseling during traumatic exposure and intensity of traumatic exposure were significantly associated with an increased risk of PTSD.Results from logistic regression indicated that the intensity of traumatic exposure, no psycho counseling during traumatic exposure were significant predictors of PTSD.Being a single child (OR =2.24, 95% CI 0.98 -5.12,P =0.057) was a trend predictor of PTSD.Conclusion The study results support that PTSD is a common mental disorder in military first responders earthquake, it is necessary to strengthen psychological protection and crisis intervention.     

军人创伤后应激障碍患者脑干听觉反应的对照研究

目的　探讨军人创伤后应激障碍 (PTSD)患者脑干听觉反应 (ABR)的特点。方法　对 36例PTSD患者和 4 0名健康军人 (对照组 )应用美国NicoletBravo脑电生理仪 ,采用Click短声刺激进行ABR测查。结果　与对照组比较 ,PTSD组的Pz脑区波V绝对潜伏期延迟 (t=4 .5 2 ,P <0 .0 1) ,OZ 脑区波V绝对潜伏期前移(t=4 .5 1,P <0 .0 1) ,OZ 脑区波Ⅱ绝对波幅与PZ 脑区波Ⅳ绝对波幅均降低 (t =5 .5 6和t =5 .5 9,均P <0 .0 1)。结论　ABR对临床辅助诊断PTSD有一定参考价值     

创伤后应激障碍的相关因素分析

目的探索＂5·12＂汶川地震发生后,灾区成年人发生创伤后应激障碍（post-traumatic stress disorder,PTSD）的危险因素,并进行认知模式、社会支持与PTSD的相关性分析。方法对来自地震极重灾区的10046名成年人进行人口学背景、地震经历调查,并使用PTSD症状检查量表（PTSD symptom checklist,PCL-17）对其进行评估,评估结果PCL-17≥50为可能PTSD患者。采用创伤后认知量表（posttraumatic cognition inventory,PTCl）评定个体的认知模式,社会支持量表（social support rating scale,SSRS）评定个体的全面社会支持状况。结果共有9342名个体的调查资料填写完整,最终纳入统计分析。年龄19～75岁,平均为（43.68±13.54）岁;男女比例为4216（45.1%）：5126（54.9%）。已婚8243人（88.2%）,未婚729人（7.8%）,离异171人（1.8%）,丧偶199人（2.1%）。受教育程度分别为初中以下5668人（60.7%）,高中以上3389人（36.3%）,不详285人（3.1%）。职业为警察350人（3.7%）,工人823人（8.8%）,农民1469人（15.7%）,公务员616人（6.6%）,教师244人（2.6%）,其它5840人（54.6%）。入组个体中有137人（1.5%）被掩埋,512人（5.5%）受伤,22人（0.2%）被截肢。地震中有家人受伤或死亡者为1521人（16.3%）。PCL-17评分〉50分者424人（4.5%）。不同婚姻状况之间的PCL-17评分有差异（F=8.669,P〈0.05）,离异及丧偶者PCL-17评分较高;警察与其他职业相比,PTSD患病率差异有统计学意义（χ2=223.490,P〈0.05）;文化程度不同,PCL-17评分也不同（F=7.425,P〈0.05）。通过Logistic回归分析发现：离异及丧偶者、警察、地震中被掩埋者、亲人严重受伤、房屋损害严重、看到其他人被埋/受伤甚或死亡者、社会支持较少等因素均是PCL-17评分较高的高危因素。相关分析显示创伤后应激症状与个人认知模式和社会支持有相关性,认知模式与创伤后应激症状呈正相关（总分r=0.607,P〈0.001）,社会支持与其呈负相关（总分r=-0.068,P〈0.001）。结论离异及丧偶者、警察、被掩埋者、截肢者及亲眼看见他人受伤或死亡是个体患PTSD的高危因素。个人认知模式和社会支持与PTSD的患病具有相关性。     

创伤后应激障碍的睡眠障碍

尽管睡眠障碍在精神疾病中非常常见，但他常常被当作精神疾病的二级症状，认为对其主要精神疾病的治疗才是缓解睡眠苦恼的最可行办法。事实上，比如创伤后应激障碍(PTSD)的噩梦并不随总症状评分的下降而减少，有时可持续很长时间，而采用针对睡眠紊乱的治疗方案后，超过50％患者的创伤后应激症状可得到有效缓解。现论述PTSD对睡眠的影响，并讨论睡眠紊乱的治疗问题。     

军人创伤后应激障碍患者事件相关电位P300研究

因P300与刺激所包含的信息及被试者的心理状态相关,故对创伤后应激障碍(PTSD)患者的P300进行了对照研究。 对象和方法 采用成组病例-对照研究设计。对象为2002年1月至2003年6月在本科门诊或住院患者,均经2名主治医师及其以上医师确诊,符合中国精神障碍分类与诊     

创伤后应激障碍的心理治疗

心理治疗被认为是创伤后应激障碍(PTSD)的首选治疗方案.根据目前的理论解释和文献研究,认知行为治疗技术如暴露治疗、焦虑管理训练、认知治疗等对PTSD比较有效.眼动脱敏和再加工 治疗方法可能对PTSD有效,但需要进一步的研究支持.本综述从理论解释、具体方法、效果研究和治疗原则等方面介绍PTSD的心理治疗技术.     

汶川地震后广元地区创伤后应激障碍调查

目的了解汶川地震9年后广元地区高二学生创伤后应激障碍(PTSD)阳性检出情况,为进一步分析震后PTSD持续存在的影响因素、对存在PTSD的学生进行心理干预提供参考。方法采用整群抽样方法,选取广元地区地震重灾区和一般灾区的1 492名高二学生为研究对象。采用创伤后应激障碍自评量表(PTSD-SS)和社会支持量表(PSSS)调查PTSD发生率和社会支持情况。结果广元地区高二学生PTSD阳性检出率为3.69%,男生和女生PTSD阳性检出率比较差异有统计学意义(2.24%vs. 5.82%,χ~2=12.47,P0.01),重灾区和一般灾区PTSD阳性检出率比较差异有统计学意义(4.89%vs. 2.84%,χ~2=4.27,P0.05);男生和女生PTSD-SS评分比较差异有统计学意义[(12.71±9.01)分vs.(14.02±8.52)分,t=-6.43,P0.01];PTSD阳性者和非阳性者PSSS评分比较差异有统计学意义[(57.52±7.53)分vs.(61.11±8.19)分,t=-5.36,P0.01]。结论汶川地震后9年,广元地区部分高二学生仍存在PTSD症状,创伤暴露程度、性别和社会支持可能与现患PTSD相关。     

玉树地震后罹患创伤后应激障碍、焦虑症和抑郁症调查

目的:调查玉树地震后不同人群创伤后应激障碍(PTSD)、焦虑症、抑郁症的发生情况。方法:抽取震后灾区人群、其非灾区的亲属人群、灾区救援人群及非灾区人群为对象,每一人群进行随机分成两组,第1组每周进行1次集体心理干预;第2组每周进行3次集体心理干预。采用PTSD检查量表平民版(PCL-C)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对不同人群在3个月、6个月进行问卷调查。结果:各人群在干预3个月和6个月均检出PTSD、焦虑症、抑郁症。各人群中第2组干预6个月时PTSD、焦虑症、抑郁症检出率明显低于干预3个月时(P均0.05)。结论:震后不同人群均存有PTSD、焦虑症、抑郁症发生;随着时间推移及积极干预可明显降低其发生。     

The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses

Objective: To determine whether post traumatic stress disorder (PTSD) and burnout syndrome (BOS) are common in nurses, and whether the co‐existence of PTSD and BOS is associated with altered perceptions of work and nonwork‐related activities. Methods: University hospital nurses were administered four validated psychological questionnaires. Results: The response rate was 41% (332/810). Twenty two percent (73/332) had symptoms of PTSD, 18% (61/332) met diagnostic criteria for PTSD, and 86% (277/323) met criteria for BOS. Ninety eight percent (59/60) of those fulfilling diagnostic criteria for PTSD were positive for BOS. When grouped into three categories: positive for PTSD and BOS (n=59), positive for BOS and negative for PTSD (n=217), and negative for both BOS and PTSD (n=46), there were significant differences in the years of employment as a nurse (P<.0001), perceptions of collaborative nursing care (P=.006), confidence in physicians (P=.01), and perception that their work impacted patient outcomes (P=.01). Nurses with BOS and PTSD were significantly more likely to have difficulty in their life outside of the work environment when compared to those with BOS alone. Conclusions: We identified that PTSD and BOS are common in nurses and those with PTSD will almost uniformly have symptoms of BOS. Co‐existence of PTSD and BOS has a dramatic effect on work and nonwork related activities and perceptions. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Inflammation and post‐traumatic stress disorder

While post‐traumatic stress disorder (PTSD) is currently diagnosed based solely on classic psychological and behavioral symptoms, a growing body of evidence has highlighted a link between this disorder and alterations in the immune and inflammatory systems. Epidemiological studies have demonstrated that PTSD is associated with significantly increased rates of physical comorbidities in which immune dysregulation is involved, such as metabolic syndrome, atherosclerotic cardiovascular disease, and autoimmune diseases. In line with this, a number of blood biomarker studies have reported that compared to healthy controls, individuals with PTSD exhibit significantly elevated levels of proinflammatory markers, such as interleukin‐1β, interleukin‐6, tumor necrosis factor‐α, and C‐reactive protein. Moreover, various lines of animal and human research have suggested that inflammation is not only associated with PTSD but also can play an important role in its pathogenesis and pathophysiology. In this review, we first summarize evidence suggestive of increased inflammation in PTSD. We then examine findings that suggest possible mechanisms of inflammation in this disorder in terms of two different but interrelated perspectives: putative causes of increased proinflammatory activities and potential consequences that inflammation generates. Given that there is currently a dearth of treatment options for PTSD, possibilities of new therapeutic approaches using pharmacological and non‐pharmacological treatments/interventions that have anti‐inflammatory effects are also discussed. Despite the increasing attention given to the inflammatory pathology of PTSD, there remains much to be elucidated, including more detailed mechanisms of inflammation, potential usefulness of inflammatory biomarkers as diagnostic and prognostic markers, and efficacy of novel treatment strategies targeting inflammation.     

Neurophysiology of threat processing bias in combat‐related post‐traumatic stress disorder

Post‐traumatic stress disorder (PTSD) is a debilitating condition that may develop after experiencing a traumatic event. Combat exposure increases an individual's chance of developing PTSD, making veterans especially susceptible to the disorder. PTSD is characterized by dysregulated emotional networks, memory deficits, and a hyperattentive response to perceived threatening stimuli. Recently, there have been a number of imaging studies that show structural and functional abnormalities associated with PTSD; however, there have been few studies utilizing electroencephalography (EEG). The goal of this study was to characterize **EEG brain dynamics in individuals with PTSD, in order to better understand the neurophysiological underpinnings of some of the salient features of PTSD, such as threat‐processing bias. Veterans of Operation Enduring Freedom/Iraqi Freedom completed an implicit visual threat semantic memory recognition task with stimuli that varied on both category (animals, items, nature, and people) and feature (threatening and nonthreatening) membership, including trauma‐related stimuli. Combat veterans with PTSD had slower reaction times for the threatening stimuli relative to the combat veterans without PTSD (VETC). There were trauma‐specific effects in frontal regions, with theta band EEG power reductions for the threatening combat scenes in the PTSD patients compared to the VETC group. Additionally, a moderate negative correlation was observed between trauma‐specific frontal theta power and hyperarousal symptoms as measured by clinically administered PTSD scale. These findings complement and extend current models of cortico‐limbic dysfunction in PTSD. The moderate negative correlation between frontal theta power and hyperarousal endorsements suggests the utility of these measures as therapeutic markers of symptomatology in PTSD patients.     

Hippocampal subfields alterations in adolescents with post‐traumatic stress disorder

Reexperiencing symptoms in adolescent Post‐Traumatic Stress Disorder (PTSD) are characterized by the apparition of vivid intrusive images of the traumatic event. The emergence of these intrusions is thought to be related to a deficiency in context processing and could then be related to hippocampal alterations. The hippocampus is a complex structure which can be divided into several subfields, namely, the Cornu Ammonis (CA1, CA2, and CA3), the subiculum, and the dentate gyrus (DG). As each subfield presents different histological characteristics and functions, it appears more relevant to consider hippocampal subfields, instead of only assessing the whole hippocampus, to understand the neurobiology of PTSD. Hence, this study presents the first investigation of structural alterations within hippocampal subfields and their links to reexperiencing symptoms in adolescent PTSD. Hippocampal subfields were manually delineated on high‐resolution MRI images in 15 adolescents (13–18 years old) with PTSD and 24 age‐matched healthy controls. The volume of the region CA2‐3/DG region was significantly smaller in the PTSD group compared to controls in both hemispheres. No other significant difference was found for other subfields. Moreover, the volume of the left CA2‐3/DG was negatively correlated with the intrusion score (as measured by the Impact of Events Scale‐Revised) in the PTSD group. To conclude, an alteration in the hippocampal subregion CA2‐3/DG, known to resolve interferences between new and similar stored memories, could participate in the apparition of intrusive trauma memories in adolescents with PTSD.