中青年首发脑卒中患者急性应激障碍动态列线图模型的构建

目的 探讨首发中青年脑卒中患者急性应激障碍的影响因素并构建动态列线图模型，以帮助医护人员早期识别急性应激障碍。 方法 选取锦州医科大学附属第一医院298例首发脑卒中的中青年患者为研究对象，其中建模组208例和验证组90例。以生物-心理-社会医学模式为理论指导，收集15个备选因素。使用LASSO回归和多因素logistic回归分析筛选出急性应激障碍的危险因素。基于R-shiny构建动态列线图预测模型，采用Bootstrap法分别在建模组和验证组进行验证。 结果 298例首发中青年脑卒中患者中141例发生ASD，发生率（47.32%）。筛选出心理韧性、ADL、神经受损程度、吞咽障碍、偏瘫5个影响因素构建预测模型。建模组验证AUC为0.884，验证组验证AUC为0.879，2次验证Calibration曲线均与理想曲线接近。 结论 所构建的动态在线列线图模型预测效能良好，可为首发中青年脑卒中患者急性应激障碍筛查提供借鉴。     

基于正念的音乐疗法对脑出血急性应激障碍伴睡眠障碍患者的影响

目的探讨基于正念的音乐疗法对脑出血急性应激障碍伴睡眠障碍患者的影响。方法将70例脑出血急性应激障碍并存睡眠障碍的患者随机分为两组,每组35例,对照组实施常规护理,干预组在常规护理的基础上进行正念舒缓音乐训练,连续干预14 d。干预前后采用多导睡眠监测(PSG)、斯坦福急性应激反应问卷(SASRQ)及匹兹堡睡眠质量指数量表(PSQI)测评两组非快动眼各期睡眠的差异、主观睡眠质量及急性应激障碍情况。结果干预后,干预组SASRQ总得分显著低于对照组,总睡眠时间占记录时间比例、NREM持续时间、3期及4期持续时间显著多于对照组(P0.05,P0.01)。结论正念音乐疗法可有效增加脑出血急性应激障碍伴睡眠障碍患者深度睡眠时间及所占比例,提高其睡眠质量,减轻患者的急性应激反应。     

肺癌患者创伤后应激障碍及睡眠状况对心理健康的影响

目的调查首诊肺癌患者创伤后应激障碍、睡眠状况及其对患者心理健康状况的影响。方法采用事件冲击量表(IES)、睡眠状况自评量表(SRSS)及症状自评量表(SCL-90)对117例首诊肺癌患者进行调查。结果患者创伤后应激障碍总均分2.46±0.33,睡眠状态总均分2.41±0.68,心理健康状态总均分1.82±0.32;创伤后应激障碍、睡眠状况与心理健康状况呈正相关(均P0.01);创伤后应激障碍、睡眠状况、患者文化程度、家庭人均收入、医疗支付方式、肿瘤分期及是否转移是肺癌患者心理健康状况的主要影响因素(均P0.01)。结论肺癌患者创伤后应激障碍、睡眠状况影响其心理健康状况,需采取针对性干预降低患者创伤后应激障碍,提高睡眠质量,改善患者的心理健康状况。     

专人卧位护理干预对急性脑卒中偏瘫患者的影响

目的 探讨实施专人卧位护理干预对急性脑卒中偏瘫患者并发症及日常生活能力的影响.方法 将104例急性脑卒中偏瘫患者按入院时间分为观察组(54例)和对照组(50例).两组均采取常规治疗和护理,观察组在此基础上实施专人卧位护理干预,4周后评定效果.结果 观察组患者肢体继发障碍、压疮、胃肠道反应和导管意外等并发症发生率显著低于对照组,日常生活能力相应提高(P＜0.05,P＜0.01).结论 实施专人卧位护理干预,可降低急性脑卒中偏瘫患者并发症的发生,提高日常生活能力.     

急性脑卒中后排尿障碍的相关因素分析

目的观察急性脑卒中患者排尿障碍的表现、特点、转归和相关危险因素。方法选取2002年3月～2010年12月笔者所在医院收治的200例急性脑卒中伴排尿障碍患者,分析不同时期的临床表现、特点、转归和相关危险因素。结果脑卒中导致尿失禁发病率很高,且出血性略高于缺血性脑卒中;脑卒中患者发病部位和类型与排尿障碍类型有相关性。结论脑卒中患者的发病部位、类型及患者的年龄、是否患有前列腺疾病、是否患有泌尿系感染是排尿困难发生的危险因素,应根据患者的具体情况谨慎对待。     

吞咽障碍筛查对降低急性脑卒中患者吸入性肺炎的作用

目的探讨吞咽障碍筛查对预防急性脑卒中患者发生吸入性肺炎的效果。方法将514例急性脑卒中患者按入院时间顺序分为对照组177例和观察组337例。对照组根据患者主诉是否有呛咳、吞咽困难界定是否存在吞咽障碍,护士遵医嘱执行饮食护理。观察组由专门接受过培训的护士采用床边吞咽试验(包括吞水试验及吞糊试验)联合监测脉冲氧饱和度评估患者吞咽功能,根据患者吞咽功能采取不同的摄食护理干预。结果观察组吞咽障碍检出率35.9%,显著高于对照组(P<0.05);吸入性肺炎的发生率为2.4%,显著低于对照组(P<0.01)。结论对急性脑卒中患者及早采用床边吞咽试验联合脉冲氧饱和度监测进行吞咽功能评估,能较客观地指导饮食护理,降低患者吸入性肺炎发生率,促进患者的整体康复。     

癌症患者创伤后应激障碍症状及影响因素的研究

目的研究癌症患者创伤后应激障碍症状及影响因素,为早期发现心理问题及提供针对性心理干预措施提供参考。方法采用PTSD筛查量表、社会支持评定量表、简易应对方式问卷、艾森克人格问卷对198例癌症患者进行调查。结果癌症患者创伤后应激障碍症状总分为(37.91±12.71)分,再体验症状群、回避/麻木症状群、警觉性增高症状群3个因子得分分别为(11.48±4.32)、(15.25±5.63)和(11.18±4.18)分;性别、年龄、文化程度、患病时间是癌症患者创伤后应激障碍症状评分的影响因素(P<0.05,P<0.01);癌症患者创伤后应激障碍症状与消极应对、神经质呈正相关,与积极应对、社会支持呈负相关(均P<0.05)。结论癌症患者创伤后应激障碍症状发生率较高,部分人口学变量及社会心理学特征会影响癌症患者的创伤后应激障碍症状。     

烧伤患者心理应激障碍分析及干预措施的研究

烧伤作为一种强烈的应激性刺激源,在其愈合过程中经历的痛苦体验、瘢痕所致的毁容和功能障碍等各种问题,均可引起烧伤患者明显的心理应激障碍,不仅对烧伤患者造成生理应激,而且可导致各种心理疾病和精神障碍的发生。烧     

循证护理在脑卒中吞咽功能障碍患者中的应用研究

目的:探讨循证护理对脑卒中吞咽功能障碍患者的临床影响.方法:对60例脑卒中吞咽功能障碍患者随机分为常规护理组和循证护理组,每组30例.观察两组患者护理后疗效和营养状况(臂围、白蛋白)的变化.结果:循证护理组患者的疗效、臂围、白蛋白明显较常规护理组改善,P<0.05.结论:循证护理显著改善脑卒中吞咽功能障碍患者的吞咽动能,提高营养状况.     

手外伤患者PTSD发生及其与手功能恢复的相关性

目的调查手外伤患者创伤后应激障碍(post-traumatic stress disorder,PTSD)的发生及其与手功能恢复的相关性。方法回顾性分析2015年3月-2019年9月收治的127例手外伤患者,调查其基本社会资料及受伤时情况,采取临床用PTSD量表(Clinician-Administered PTSD Scale,CAPS)以及上肢功能评分表(disability of arm-shoulder-hand,DASH)评估患者术后(平均15个月)的心理状态和手功能恢复情况,采用SPSS 19.0软件进行数据分析。结果127例手外伤患者PTSD的发生率为41.73%;婚姻状况、受伤指数、受伤程度是手外伤患者发生PTSD的影响因素(P<0.05),月收入、受伤原因是该类患者PTSD发生的显著影响因素(P<0.01);手外伤患者PTSD的发生与其手功能评分呈显著正相关(r=0.842,P<0.01)。结论手外伤患者PTSD发生率高,受婚姻状况、受伤指数、受伤程度、月收入、受伤原因等多种因素影响,且与其手功能恢复程度密切相关。临床上应关注该类患者功能恢复中的心理症状,减少不良应激,以便促进功能康复。     

Effects of Varying Diagnostic Criteria for Posttraumatic Stress Disorder Are Endorsing the Concept of Partial PTSD

The purpose of the present study was to investigate the appropriateness of different diagnostic criteria sets for posttraumatic stress disorder (PTSD). This was done by varying diagnostic criteria on the diagnosis of PTSD in a study group of N = 146 former political prisoners, and comparing the resulting diagnostic groups with a study group of N = 75 nontraumatized controls with regard to mean scores on measures of subjective distress (i.e., IES-R, BDI, BAI, SCL-90-R). The findings did not support the diagnostic boundaries as defined by the DSM-IV or the lowering of the avoidance criterion from three to two symptoms. The concept of partial PTSD appeared to be the most appropriate way to provide diagnostic coverage for those who did not meet full DSM IV criteria.     

Peritraumatic Versus Persistent Dissociation in Acute Stress Disorder

The DSM-IV definition of acute stress disorder (ASD) regards dissociation that occurs during a trauma (peritraumatic dissociation) comparably to persistent dissociation. This study investigated the relative contributions of peritraumatic dissociation and persistent dissociation to acute posttraumatic stress reactions. Civilian trauma (N = 53) survivors with either acute stress disorder (ASD), subclinical ASD, or no ASD were administered modified versions of the Peritraumatic Dissociative Experiences Questionnaire that indexed both dissociation during the trauma and dissociation at the time of assessment. Persistent dissociation was more strongly associated with ASD severity and intrusive symptoms than peritraumatic dissociation. These results are consistent with the proposition that persistent, rather than peritraumatic, dissociation is associated with posttraumatic psychopathology.     

Are the dissociative criteria in ASD useful?

Acute stress disorder (ASD) is a new DSM-IV diagnostic category, characterized by dissociative, intrusive, avoidance, and hyperarousal symptoms in the first month after a traumatic experience. The goal of the present study was to examine the utility of this diagnosis. In a prospective study, 79 mixed trauma victims who met DSM-IV symptom criteria for PTSD within 1 month following a traumatic event were followed through three months post-event. Dissociative symptoms in ASD only partially captured distress and dysfunction during the first month. Participants with and without ASD showed similar patterns of recovery, with only small differences that disappeared at three months post-event. Interestingly, initial PTSD avoidance but not ASD dissociative symptoms predicted PTSD severity at 3 months.     

Reconstructing trauma memories: a prospective study of "amnesic" trauma survivors

The purpose of this study was to investigate memory for trauma in patients who were initially amnesic of the trauma as a result of mild traumatic brain injury (MTBI). Motor vehicle accident survivors who sustained a MTBI were assessed for their memory within 1-month posttrauma (n = 79) and again at 2-years posttrauma (n = 50). Consistent with their brain injury, all patients reported significant amnesia of their accident at initial assessment. At 2-years posttrauma, 40% were able to remember their accident. Reporting memory for the trauma was associated with shorter duration of posttraumatic amnesia. These findings suggest that people reconstruct memories of trauma in the absence of complete encoding of the experience. Possible mechanisms for memory reconstruction are considered.     

Implosive therapy for the treatment of combat-related PTSD

Implosive therapy for the treatment of post-traumatic stress disorder is based on the principle of exposing the patient to trauma-related cues until there is a reduction in the anxiety associated with the cues. It is a relatively specialized procedure regarding which few clinicians receive extensive supervised training, despite the numerous case studies that demonstrate its effectiveness. The present paper addresses a number of procedural issues and offers guidelines for conducting implosive therapy with traumatized combat veterans. Elements of controversy regarding the application of implosive therapy are discussed.     

Post-traumatic stress disorder

Developments in the study of psychological trauma are briefly charted, prior to the inclusion of the stressor-generic diagnostic category of ‘post-traumatic stress disorder’ (PTSD) in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Against the context of the assumptions underlying the DSM-III classification system, evidence relating to the general validity of the PTSD diagnostic criteria is examined. Progress in the development of assessment techniques and psychotherapeutic procedures is reviewed. and proposals for refinement and revision of the diagnostic category are considered.     

The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder

This study examined the relationship between childhood sexual abuse and symptoms of a newly proposed complex posttraumatic stress disorder or disorder of extreme stress not otherwise specified (DESNOS). Compared to 34 women without histories of sexual abuse, 74 survivors of sexual abuse showed increased severity on DESNOS symptoms of somatization, dissociation, hostility, anxiety, alexithymia, social dysfunction, maladaptive schemas, self-destruction, and adult victimization. In addition, a logistic regression found that a complex of symptoms representing DESNOS was significantly related to a history of sexual abuse. Consistent with other studies, the results of this study provide support for the idea that symptoms of DESNOS characterize survivors of sexual abuse.     

Posttraumatic Stress Disorder Following Diagnosis of Multiple Sclerosis

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) recognizes life-threatening illness as a potential stressor that can precipitate posttraumatic stress disorder (PTSD). This study represents the first study of PTSD in the context of having a diagnosis of multiple sclerosis (MS). Fifty-eight MS patients were administered the Clinician Administered PTSD Scale, the Geriatric Depression Scale, and Disease Steps Questionnaire. Nine participants (16%) met symptom criteria for PTSD. In terms of those who satisfied the reexperiencing criterion, 75% of participants reported intrusions related to future-oriented concerns about their prognosis. These findings suggest that a significant proportion of MS patients experience PTSD-type reactions. These results are discussed in terms of the suitability of the PTSD framework to account for the distinctive nature of stress reactions secondary to life-threatening illness.     

Toward an MMPI trauma profile

This paper presents findings of a common MMPI profile configuration for a small forensic sample (n=16) of persons traumatized by life-threatening civilian events or as a consequence of combat in the Vietnam War. All subjects were involved in lawsuits in which the issue of compensation, medical benefits, or criminal disposition and sentencing were important concerns. A review of the existing empirical studies using this full MMPI scale as well as the MMPI post-traumatic subscale are discussed. In comparing the civilian and veteran samples on the MMPI clinical, validity, and subscales a number of statistically significant differences were found by analyses of variance and mean comparison tests of the data. While the profile configuration of both groups were similar (elevations onF, 8 and 2 scales), the Vietnam Veteran sample had significantly higher elevations. It was concluded that identifying an MMPI trauma profile and its variations may aid in the diagnosis and assessment of post-traumatic stress disorder.Based, in part, on a chapter inTrauma, Transformation and Healing: An Integrated Approach to Theory, Research and Treatment, John P. Wilson, Brunner/Mazel, New York.