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。     

Clinical Review and Epidemiology of Headache Disorders in US Service Members: With Emphasis on Post-traumatic Headache

Migraine or headache is a common problem in the active duty population, in the recently deployed service members, and is a cardinal symptom of traumatic brain injury. While there is increasing appreciation of the clinical burden of post-traumatic headache (PTHA) in the military traumatic brain injury population, there remain significant research gaps related to the epidemiology of PTHA, including lack of understanding of natural history, whether there are predisposing factors that predict the development or prognosis of headache post trauma and, most basically, the features that distinguish PTHA from other forms of chronic headache. Although diagnostic criteria for PTHA are included in the International Classification of Headache Disorders, 2nd edition, revised, these criteria are somewhat arbitrary and were not empirically defined. This lack of precision about the PTHA phenotype limits the rigor of observational studies of PTH but does not appear to significantly hamper treatment, provided the treatment involves a multi-modality approach.     

Jaw symptoms and signs and the connection to cranial cervical symptoms and post-traumatic stress during the first year after a whiplash trauma

Purpose.?To estimate the prevalence of jaw symptoms and signs during the first year after a neck sprain in a car collision. Further, to determine their relationships to the localisation and grade of the initial neck symptoms and signs, headache, post-traumatic stress and crash characteristics.

Methods.?One hundred and forty-six adult subjects and crash characteristics were prospectively investigated in an in-depth study during 1997–2001. Head, neck, and jaw symptoms and signs were recorded within 5 weeks and after 1 year. Acute post-traumatic stress was estimated with the Impact of Event Scale-Revised (IES-R).

Results.?Jaw symptoms were initially reported by three men (5%) and three women (4%), and subsequently developed in eight women (10%) during the following year. Jaw signs were noted initially in 53 subjects (37%) and in 28 subjects (24%) after 1 year, without difference between sexes, and more often after low-speed impacts. Headache in females, cranial cervical symptoms, pronounced neck problems, post-traumatic stress and whiplash-associated disorders (WAD) grade II–III after rear-end impacts were related to jaw signs during the acute phase. After 1 year, jaw signs were related to residual neck problems, headache and post-traumatic stress.

Conclusions.?Jaw symptoms are seldom reported during the acute phase after a whiplash trauma. Women more often than men develop jaw symptoms during the first year. Jaw symptoms and signs may develop also after low-speed impacts, especially after rear-end collisions. Jaw symptoms and signs should be observed after whiplash trauma, especially in those with headache, pronounced neck problems, cranial neck symptoms and post-traumatic stress.     

Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury

A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where “psychoeducation” was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation—the Rehabilitation Treatment Specification System—can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.     

Psychological sequelae: post-traumatic stress reactions and personality factors among community residents as secondary victims

The aims of the present study were twofold: first, to ascertain the severity of post-traumatic stress among community residents as secondary victims exposed to a train disaster. Secondly, we aimed to identify the association between post-traumatic stress and personality variables. Seven months after the train disaster in Stafford, United Kingdom, in 1996, 66 community residents were recruited and interviewed for the study. In the interviews, residents were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ) and the Eysenck Personality Questionnaire-R Short Scale (EPQ-R). Control group data were also collected, composed of 90 community residents who lived in another city and had not been exposed to the train disaster. They were assessed using the GHQ. The results showed that 51% of the residents scored at the high IES symptom level. No significant differences were found between the community residents who lived near and further away from the crash site in terms of the IES scores. Further analyses showed that the IES scores for the present two groups of community residents were significantly lower than those of Horowitz's standardized stress clinic samples, but higher than those of Danish rescue workers involved in a train rescue operation. The GHQ results showed that 35% could be considered to be psychiatric cases. The comparisons between the GHQ scores of the present community residents with those of the control group showed that there were significant differences in somatic problems, anxiety, depression and GHQ total. With regard to personality, the community residents who lived near to the crash site were significantly more introverted but less neurotic than Eysenck's standardized samples. The community residents who lived further away were significantly more introverted but less neurotic than the standardized samples. Regression analyses revealed that neuroticism predicted intrusion, avoidance and GHQ total. The conclusion was that there can be long-term, severe post-traumatic stress effects upon community residents, as secondary victims, after exposure to a train disaster. Residents with a neurotic personality tend to be associated with post-traumatic stress reactions and general health problems.     

意外创伤者的创伤后成长研究

对意外创伤、创伤后成长的概念及研究现状进行分析,提出意外创伤研究中引入创伤后成长的可能性。     

CAM and Post-Traumatic Stress Disorder

In the form of the Transcendental Meditation program CAM offers a method of eliminating deep-rooted stress, the efficacy of which has been demonstrated in several related studies. Any discussion of CAM and post-traumatic stress disorder should include a study of its application to Vietnam War Veterans in which improvements were observed on all variables, and several participants were able to return to work after several years of being unable to hold a job. The intervention has been studied for its impact on brain and autonomic nervous system function. It has been found to be highly effective against other stress-related conditions such as hypertension, and to improve brain coherence-a measure of effective brain function. It should be considered a possible 'new and improved mode of treatment' for PTSD, and further studies of its application made.     

103例颅脑损伤患者创伤后成长状况及相关因素研究

目的:对颅脑损伤患者进行创伤后成长的测量,探讨成长理念在颅脑损伤人群中的适用性并分析不同特征者的得分差异及其相关因素.方法:采用随机抽样的方法,应用创伤后成长量表对103例轻、中型颅脑损伤的患者进行调查.结果:颅脑损伤患者的创伤后成长得分为(63.28±14.61)分,低龄、女性患者的成长得分要高于高龄、男性的分值.年龄、性别差异显著(P＜0.05).结论:颅脑损伤患者存在一定程度的创伤后成长,医护人员在其康复的过程中既要关注损伤带来的不良影响,同时也不能忽视患者的积极体验,应根据患者的实际情况给予患者个体化的有效的心理指导,以促进身心全面恢复.     

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。     

意外创伤者的创伤后成长研究

对意外创伤、创伤后成长的概念及研究现状进行分析,提出意外创伤研究中引入创伤后成长的可能性.     

Late post-traumatic headache in pediatric age

In this study we evaluate the incidence and clinical characteristics of headache which arise 12-18 months after a cranial trauma in a pediatric age group of subjects. We contacted 217 individuals who had been hospitalized for head injury to return for check-up; of the 138 who responded, there were 86 males and 52 females (mean 9.2 years). The responders were given a complete physical and neurological examination and, in the presence of at least one parent, asked to fill out a headache questionnaire. Twenty-nine per cent suffered from headache, and in 6.5% the headache was migrainous in nature. The 138 patients were split up into three sub-classes in accordance with the nature of the trauma and two sub-classes in accordance with the presence or absence of fractures. The results were then compared with those obtained from a control population (246 patients with a mean age of 8.8 years). An increased headache frequency was found in those patients with average to severe trauma. We conclude that cranial trauma is not likely to be followed by headache unless accompanied by loss of consciousness and/or focal neurological signs.     

The mental health consequences of terrorism: implications for emergency medicine practitioners

Emergency physicians are likely to be first-line responders in any local or regional terrorist event. In addition to preparing for the potential physical conditions and injuries that are associated with terrorism, they should be aware of the behavioral and mental health implications as well. It is helpful to be familiar with the characteristics that predict who may be at increased risk for mental illness after such events and how they may be identified in an Emergency Department setting. Although most people in the general population with behavioral conditions stemming from a terrorist event can be expected to recover spontaneously within several months, other individuals are at increased risk of developing more debilitating mental health conditions that have been associated with post-terrorist and disaster environments. Screening tools are available to help emergency practitioners identify them and refer patients for more formal psychiatric evaluation and potential interventions to facilitate and speed the recovery process.     

心理治疗对脑外伤后综合征患者的康复疗效

目的 :探讨介入心理治疗对脑外伤后综合征患者康复疗效的影响。方法 :10 5例脑外伤后综合征患者分为 2组。常规组 5 1例给予常规治疗 ;心理组 5 4例在常规治疗时介入心理治疗。 2组均于初诊及治疗 1个月后用症状自评量表 (SCL 90 )评定患者的躯体化症状和心理状况。 3个月后用功能状态问卷 (FSQ)评定患者的社会生活能力。结果 :治疗后 ,2组患者的躯体症状和心理状况、社会生活能力均有改善 ,但心理组的改善程度较常规组显著(P <0 .0 5 ,P <0 .0 0 5 )。结论 :心理治疗的介入有助于提高脑外伤后综合征患者的康复治疗效果     

Children and war: current understandings and future directions

During the last decade, the number of children whose lives have been disrupted by war, oppression, terror, and other forms of conflict has grown tremendously. When the United Nations High Commission for Refugees was first established during the 1950s to provide international protection to refugees following World War II, it was estimated that there were 1.5 million refugees and displaced persons. Today there are approximately 14 million, about three-fourths of whom are women and children. Although the experiences of refugee children and adolescents vary considerably, many have witnessed or experienced the death or murder of loved ones. Upon resettlement, they face numerous challenges. Research with this population is a relatively new area of investigation, but there is evidence that many of these young people experience long-term physical and emotional health problems. In this article, current research findings are reviewed, the widespread emphasis in the literature on post-traumatic stress disorder (PTSD) is critically examined, future research directions are suggested, and implications for public health nurses are addressed.     

Post-traumatic stress disorder in episodic and chronic migraine

OBJECTIVE: To assess and contrast the relative frequency of self-reported post-traumatic stress disorder (PTSD) in patients with episodic migraine and chronic/ transformed migraine. BACKGROUND: Several risk factors have been identified as risk factors for chronification of headache disorders. Childhood abuse has been suggested as a risk factor for chronic pain in adulthood. In addition depression, as well as several other psychiatric disorders, are co-morbid with migraine. Recent data suggest that PTSD may be more common in headache sufferers than in the general population. METHODS: This was a prospective, pilot study conducted at a headache center. Adult subjects with episodic, chronic, or transformed migraine were included. Demographic information, depression history, body mass index (BMI), and headache characteristics were obtained. PTSD was assessed using the life events checklist (LEC) and the PTSD checklist, civilian version (PCL-C). We contrasted the data from episodicmigraineurs and chronic/transformed migraine participants (CM) and conducted multivariate analyses, adjusting for covariates. RESULTS: Of the 60 participants included, 91.7% were female with a mean age of 41.4+/-12.5 years old. EM was diagnosed in 53.3% and CM in 46.7%. The mean BMI was not significantly different between groups. In contrast, the relative frequency of depression was significantly greater in subjects with CM (55.2%) than EM (21.9%, P=.016). There was no significant difference in the percentage of participants reporting at least 1 significant traumatic life event (LE) or in the mean number of traumatic LEs between EM and CM participants. However, the relative frequency of PTSD reported on the PCL in CM (42.9%) was significantly greater as compared to EM (9.4%, P=.0059. After adjusting for depression and other potential confounders, the difference remained significant P=.023). CONCLUSION: PTSD is more common in CM than in episodic migraineurs. This suggests that PTSD may be a risk factor for headache chronification, pending longitudinal studies to test this hypothesis.     

Post-traumatic stress reactions among individuals with visual impairments: a systematic review

Purpose: To conduct a systematic review of post-traumatic stress reactions among individuals with visual impairment (VI).

Materials and methods: Qualitative and quantitative studies were identified through searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Libraries. The literature search was limited to humans, of English and Scandinavian languages and publication year between 1980 and 2017. Study quality was assessed for all the included studies and extracted data were synthesized using narrative analysis.

Results: Of 4235 records identified through literature search, eleven were included in the analyses. Results from the qualitative studies illustrated multiple physical, behavioral, emotional, and cognitive manifestations of trauma. Four out of five quantitative studies showed that various types of potentially traumatic events were significantly associated with mental health adversities (p?<?0.05). The prevalence of post-traumatic mental disorders was 4–21.2% for depression, 0.9% for dysthymia, and 32% for substance misuse. The quality of the reviewed studies was considered low to moderate.

Conclusion: Traumatic experiences appear to have a great impact on the mental health in people with visual impairment (VI) and these results highlight their need for mental health care. Future studies with higher methodological rigor are recommended.

• Implications for rehabilitation

• Visual impairment entails a greater susceptibility to some types of potentially traumatic events, especially threats in everyday life. This calls for a greater emphasis on safe community environments and universal design in public spaces.

• In rehabilitation after serious accidents or potentially traumatic events, professionals working with people with vision impairment should be aware of the different manifestations of post-traumatic stress responses and that some stress responses may cause additional disability.

• The high prevalence of traumatic events and their impact on mental health in individuals with visual impairments highlights a need of mental health care.

     

Epidemiological characteristics and prognostic factors of post-traumatic endophthalmitis

ObjectiveTo examine the prognostic factors and features of post-traumatic endophthalmitis.MethodsThis retrospective study enrolled adult patients (>18 years old) diagnosed with post-traumatic endophthalmitis. Their medical records were reviewed and the patient demographic characteristics, features of injury, management, outcomes and microbiology data were analysed.ResultsA total of 131 eyes from 131 patients were enrolled. Post-traumatic endophthalmitis was more common in male patients (122 of 131 patients: 93.1%), in those aged 30–44 years (51 of 131 patients: 38.9%), in those injured with a metallic object (86 of 131 patients; 65.6%), in those with a penetrating injury (90 of 131 patients; 68.7%) and those that were injured at work (106 of 131 patients; 80.9%). The mean ± SD time of presentation to the hospital and developing endophthalmitis was 40.60 ± 19.32 h and 5.19 ± 2.55 days, respectively. Of the cultures, 84 of 131 (64.1%) were negative and 22 of 131 (16.8%) were positive for Staphylococcus species. Patients with delayed presentation, an intraocular foreign body, traumatic cataract, retinal detachment, larger wounds, positive smears and cultures and work-related injuries had worse outcomes.ConclusionImmediate presentation to an ophthalmic centre and timely diagnosis and intervention may lead to better outcomes.     

Trauma, PTSD and personality: the relationship between prolonged traumatization and personality impairments

Objective:  Chronic post-traumatic stress disorder (PTSD) has been associated with personality impairments involving externalized and internalized psychopathology. This study has explored the association between PTSD symptoms as consequences of prolonged torture experiences or early childhood trauma exposure and personality traits.
Method:  One hundred and sixty-one men were included: 36 Iraqi men refugees (mean age = 43.9, SD = 8.7) who had longstanding torture experiences as adults; 42 Swedish prisoners (mean age = 33.8, SD = 7), with early childhood trauma exposure; 31 Arab men refugees (mean age = 41.8, SD = 8.9) without self-reported torture or violence experiences; 52 non-traumatized Swedish males (mean age = 39.3, SD = 5.5). They were assessed for symptoms of PTSD or PTSD hypothetical clusters. Personality profile was assessed by the Karolinska Scales of Personality (KSP). Factor analysis with varimax rotation was conducted and yielded three factors: externalized, internalized and avoidance domains.
Results:  Individuals who suffered prolonged torture experiences or had early childhood trauma exposure showed impaired personality profiles in internalized and externalized domains. Individuals with or without PTSD showed significant differences p < 0.05 concerning: internalized, externalized and avoidance. anova and post-hoc analysis according to Scheffé showed that the prolonged torture group > early childhood trauma exposure > nontraumatized group.
Conclusion:  Prolonged torture experiences or early trauma exposure may impair personality formation by enhancing the effects of cognitive, affective and behavioural vulnerabilities.     

Issues and dynamics of sexually assaulted adolescents and their families

Interpersonal violence such as sexual assault creates a variety of traumatic responses. Adolescents encounter a significantly high rate of exposure to sexual assault. In the aftermath of sexual assault, issues and dynamics related to traumatic responses include ongoing fear and threats to personal safety, stability, and structure of the family and environment. Each issue is of concern for community and health care practitioners. Sexual assault has a detrimental effect on adolescent intrapsychic development and interpersonal relationships. Symptoms are disturbing and disruptive to daily routines, negatively affect adolescent normal growth and development, and can result in post-traumatic stress disorder. Issues and dynamics regarding sexual assault are explored, with suggestions on how to help adolescents avoid developing a negative world view and long-term negative health consequences.