颅脑损伤患者术后创伤后成长与创伤后应激障碍的相关性

目的观察颅脑损伤患者术后创伤后成长水平及创伤后应激障碍(PTSD)情况,分析创伤后成长水平与PTSD的关系。方法选取2017-02—2019-02郑州市第九人民医院手术治疗的63例颅脑损伤患者,所有患者术后1个月接受创伤后成长评定量表(PTGI)评估,依据评估结果分为高水平组与低水平组,调查2组一般资料并评估患者术后PTSD评分,分析颅脑损伤患者术后PTSD与创伤后成长水平较低的关系。结果63例颅脑损伤患者经外科手术治疗后,创伤后成长低水平患者43例(68.25%)。不同创伤后成长水平的颅脑损伤患者年龄、性别、婚姻、职业、家庭月收入、发病原因、疾病类型、居住环境情况比较差异无统计学意义(P>0.05);低水平患者受教育年限(<12 a)、PTSD评分高于高水平患者,差异有统计学意义(P<0.05)。相关性分析显示,颅脑损伤患者术后创伤后成长与PTSD间呈负相关(r<0,P<0.05)。经单项Logistic回归分析,建立多元回归模型,在在校正各基线资料带来的影响后,结果显示受教育年限(<12 a)、PTSD可能是颅脑损伤患者术后创伤后成长水平低下的影响因素(OR>1,P<0.05)。结论颅脑损伤患者术后创伤后应激水平偏低,可能与PTSD有关,未来可考虑通过颅脑损伤术后早期评估患者是否伴有PTSD指导干预,可能对提高患者创伤后成长水平有积极意义。     

创伤性颅脑损伤伴胫骨骨折患者反刍性沉思与创伤后成长的相关性

目的 观察创伤性颅脑损伤(TBI)伴胫骨骨折患者创伤后成长(PTG)水平,分析患者反刍性沉思与PTG的关系.方法 选取郑州市第九人民医院2019-04—2020-07收治的81例TBI伴胫骨骨折患者为研究对象,采用创伤后成长量表(PTGI)评估患者PTG水平并分组;设计基线资料调查问卷,采集患者基线资料,比较反刍性沉思...     

地震后半年未愈伤员创伤后应激障碍调查

目的：探讨汶川地震灾后半年,震伤未愈伤者创伤后应激障碍（PTSD）的发生率和相关因素。方法：选取成都市某医院地震伤员康复中心未愈伤者58例,采用自制一般情况问卷、心理健康自评问卷、分离性体验量表、PTSD自评量表和特质应对方式问卷进行测评。结果：未愈伤者在地震灾后半年患PTSD者占41.4%;男性伤者中残疾率28.6%和PTSD发生率28.6%明显低于女性伤者的46.7%和53.3%（P〈0.05）。创伤后应激水平与积极应对方式呈正相关（r=0.483,P〈0.01）;和消极应对方式呈负相关（r=-0.449,P〈0.01）。伤者中分离水平极低,遗忘和创伤后应激水平呈正相关（r=0.541,P〈0.01）;残疾、低社会支持和创伤后应激水平显著相关（r=0.642,P〈0.05）。结论：地震灾后半年,震伤未愈伤者PTSD患病率较高,残疾、社会支持差、遗忘水平高、消极的应对方式是震伤未愈者发生PTSD的主要相关因素,应给予充分的药物及心理治疗。     

艾司西酞普兰合并动力性分析治疗创伤后应激障碍的临床研究

目的 探讨艾司西酞普兰合并动力性分析对创伤后应激障碍的疗效.方法 48例创伤后应激障碍患者随机分为研究组24例（艾司西酞普兰合并动力性分析）和对照组24例（单用艾司西酞普兰）,疗程为12周,采用创伤后应激障碍清单（PCL-C）、状态-特质焦虑问卷（STAI）和抑郁自评量表（SDS）于治疗前及治疗第4、8、12周末评定疗效.结果 治疗后第4、8、12周末,两组PCL-C的闯入性症状、高警觉性、回避症状评分及PCL-C总分均显著低于治疗前（P＜0.05,P＜0.01）;治疗后第8周末研究组PCL-C闯入性症状、高警觉性评分显著低于对照组（P＜0.05,P＜0.01）;治疗后第12周末,研究组PCL-C闯入性症状、高警觉性评分及PCL-C总分均显著低于对照组（P＜0.05,P＜0.01）.治疗后第4、8、12周末,两组的STAI中状态焦虑评分及SDS总分均显著低于治疗前（P ＜0.05,P＜0.01）;治疗后第8、12周末,研究组STAI中状态焦虑评分及SDS总分显著低于对照组（P＜0.05）.研究组显效率（70.83％）显著高于对照组（50.00％）（P＜0.05）.结论 艾司西酞普兰合并动力性分析对创伤后应激障碍的疗效较单用艾司西酞普兰更好.     

创伤后应激障碍与血同型半胱氨酸、叶酸及维生素 B12的相关性

目的 探讨创伤后应激障碍（PTSD）患者应激症状与血同型半胱氨酸、叶酸、维生素B12 代 谢的相关性。方法 2016 年11 月—2017 年11 月对驻疆某部官兵经历创伤性事件后，按照创伤后应激 障碍筛查量表（PCL-C）评分阳性和美国精神疾病诊断统计手册第五版（DSM-5）的诊断标准，根据是否为 PTSD分为PTSD组（n=27）和在相同暴露条件下的未患PTSD的对照组（n=39）。对两组空腹血浆同型半胱 氨酸、叶酸、维生素B12 及部分其他血液学指标进行分析。结果 PTSD组血同型半胱氨酸水平高于对照 组，叶酸、维生素B12 水平、T3、T4低于对照组，差异均有统计学有意义，而TSH、LDL、HDL-C 组间比较， 差异均无统计学意义。结论 PTSD患者其血同型半胱氨酸较高，叶酸及维生素B12 水平较低。     

创伤后应激障碍的实验动物模型

创伤后应激障碍（PTSD）的临床特征主要表现为创伤经历再体验、过度觉醒、情感麻木与回避行为等症状.而动物模型的建立对了解创伤后PTSD的病因学、PTSD临床表现及其治疗具有重要的作用.本文就目前常用的PTSD动物模型进行综述.     

舟曲儿童创伤后应激障碍与家庭环境因素的关系分析

目的探讨创伤后应激障碍与家庭环境因素的关系,为创伤后应激障碍的治疗方向提供依据。方法采用分层整群抽样的方法用家庭环境量表中文版(FES-CV)和创伤后应激障碍17项筛查问卷(PCL-C)对舟曲县的596名学生和家长进行问卷调查,获得学生和家长有效问卷各554份。结果 PTSD筛查阳性组共33人,占总人数的6.0%;女生在PCL-C量表上的得分显著高于男生(P<0.01);男女生平均分在PTSD筛查阴性组存在极显著性差异(P<0.01),而在PTSD筛查阳性组不存在显著性差异(P>0.05);对家庭环境量表各因子做具体分析,发现PTSD筛查阴性组与PTSD筛查阳性组在组织性因子方面存在极显著性差异(P<0.01);PTSD筛查阴性组男女生在亲密性和组织性因子得分上存在显著性差异(P<0.05),而PTSD筛查阳性组男女生在各因子得分上均不存在显著性差异(P>0.05)。结论家庭环境因素中亲密性和组织性对儿童创伤后应激障碍有重要影响,教会家长如何增强家里的亲密性和组织性维度,可以有效预防和治疗PTSD。     

创伤后应激障碍发生自杀的研究进展

随着近年来对创伤后应激障碍（PTSD）的关注越来越多,目前认为PTSD患者自杀率远远高于普通人群,因此,早期识别自杀并干预将具有重大的医学和社会意义。现从PTSD发生自杀的流行病学、影响因素、生物学机制及干预几个方面进行综述。     

老年患者体外循环心脏手术后创伤后应激障碍的危险因素

目的 老年患者接受体外循环心脏手术术后出现创伤后应激障碍(PTSD)的危险因素.方法 选择2019年5月～2020年5月我院150例老年心脏疾病患者为研究对象,均采用体外循环心脏手术治疗,采用PTSD筛查量表-居民版(PCL-C)进行PTSD筛查,根据结果设为PTSD组与非PTSD组,对两组患者年龄、性别、心脏功能等资...     

高频重复经颅磁刺激联合帕罗西汀治疗创伤后应激障碍的疗效

目的 观察高频重复经颅磁刺激（rTMS）对创伤后应激障碍（PTSD）的辅助疗效.方法 将60例创伤后应激障碍患者随机分为联合组及对照组,联合组采用帕罗西汀治疗,配合右侧前额叶背外侧部、10Hz高频rTMS.对照组采用帕罗西汀治疗及假性重复经颅磁刺激治疗.两组患者均治疗4周,并进行基线、治疗后创伤后应激障碍检查表（PCL）及汉密尔顿抑郁测评量表（HAMD）、汉密尔顿焦虑测评量表（HAMA）评定.结果 57例患者完成研究,两组患者治疗后PCL总分及重现、回避、警觉性增高因子分、HAMD、HAMA评分均较治疗前降低,差异有统计学意义（P＜0.05）;联合组治疗4周末PCL测评总分、重现、警觉性增高因子、HAMA治疗前后评分差均较对照组高,差异有统计学意义（P＜0.05）.结论 帕罗西汀能够改善PTSD的核心症状及抑郁、焦虑症状;在帕罗西汀治疗基础上,10 Hz重复经颅磁刺激能够增加对PTSD的重现、警觉性增高等核心症状及焦虑症状的疗效.     

老年脑梗死患者创伤后成长与自我效能的相关性

目的 观察老年脑梗死患者自我效能状况,并分析自我效能与创伤后成长(PTG)的关系,为提高脑梗死患者自我效能提供指导.方法 选取2018-01—2020-03郑州市第九人民医院收治的83例老年脑梗死患者为研究对象,参照自我效能感量表(GSES)评估患者入院时自我效能状况并分组,采集并比较患者基线资料,采用PTG评定量表(...     

Which symptoms of post-traumatic stress disorder are associated with suicide attempts?

Individuals with post-traumatic stress disorder are at increased risk for suicide attempts. The present study aimed to determine which of the specific DSM-IV symptoms of post-traumatic stress disorder (PTSD) are independently associated with suicide attempts. Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC has a sample size of N = 34 653. The full sample size included in analyses was 2322 individuals with PTSD. Among individuals with lifetime PTSD, after adjusting for sociodemographic factors, as well as any mood, substance, personality, or anxiety disorder (excluding PTSD), increasing numbers of re-experiencing and avoidance symptoms were significantly correlated with suicide attempts. Of the specific symptoms, having physical reactions by reminders of the trauma, being unable to recall some part of it, and having the sense of a foreshortened future, were all associated with suicide attempts. These findings will help extend our understanding of the elevated risk for suicide attempts in individuals with PTSD.     

Trauma exposure and post-traumatic stress disorder in intensive care unit personnel

A questionnaire-study on work related trauma was conducted at 15 intensive care units. 144 examined female and male (17%) nurses provided information on the type and frequency of highly stressful job experiences, symptoms of posttraumatic stress disorder (PCL-C), depression (ADS-K) and cognitive-emotional coping style (FAPK 1.3). The study participants had an average age of 32 and an average job experience of 8 years. They reported an average of 38 traumatic job experiences in which they were confronted with seriously injured, mutilated and dying patients, corpses and their own anxiety and helplessness. 88% suffered from intrusive symptoms, 75%) from arousal symptoms; 41% had developed post-traumatic stress disorder (PTSD). Compared with less disturbed participants nurses with PTSD reported significantly more often on depressive symptoms and deficiencies in emotional competence.     

Factors that hinder post-traumatic growth: A systematic review

People who experience major life crises often report post-traumatic stress. However, the literature suggests that traumatic experiences can also be “catalysts” for positive change (i.e., post-traumatic growth; PTG). PTG can include improved relationships, new possibilities for one's life, a greater appreciation for life, a greater sense of personal strength, and spiritual development. Furthermore, it has been suggested that PTG may decrease feelings of distress following exposure to trauma. While a large number of factors may help promote PTG, others may impede the development of growth (e.g., attachment style). These factors constitute key aspects for clinicians working with victims of trauma. Thus, this review aims to present these hindering factors in order to provide guidance for trauma psychologists and future research.     

Psychosis and trauma. Theorical links between post-traumatic and psychotic symptoms

Introduction

The co-occurrence between post-traumatic symptoms and psychotic symptoms is well described in the immediate suites of a trauma but can also be chronic. This symptomatic co-occurrence, rarely studied in the literature, is often approached under the sole angle of a primary post-traumatic stress disorder (PTSD) or of a primary psychosis, without federative will to unify the psychotic and post-traumatic symptoms within the same nosological framework. Individuals with schizophrenia or schizoaffective disorder report higher rates of trauma and assault than the general population.

Literature findings

High rates of PTSD have been noted in severe mental illness cohorts. Psychotic phenomena may be a relatively common manifestation in patients with chronic PTSD.

Aim

The purpose of this paper is to expose the various theorical psychopathological aspects between the symptoms of psychosis and PTSD. In populations of veterans, positive and negative symptoms of psychosis in PTSD are described as delusional thoughts and hallucinations often combat-specific.

Clinical findings

When a PTSD becomes established at a subject to the personality of neurotic structure, the intensity of the PTSD's symptoms lead to a psychotic expression which constitutes a factor of seriousness. Besides, PTSD often induces a risk of substance use disorder supplying psychotic symptoms. Cannabis increases the hallucinations, cocaine strengthens an underlying paranoid tone, and alcohol implies withdrawal hallucinosis. Moreover, such consumption could be a risk factor for the future development of chronic psychosis. From another point of view, by basing themselves on the plasma dopamine beta-hydroxylase activity, some authors made the analogy between psychotic major depression and PTSD with psychotic features (also characterized as a distinct psychotic subtype of PTSD). However, other studies found no correlation between PTSD with psychotic features and family predisposition for schizophrenia or schizoaffective disorder.

Discussion

The determination of the structure of personality seems fundamental in the understanding of the symptoms. A personality of psychotic structure increases the risk of traumatization and PTSD. At the same time, the fragility of this structure causes an increased sensitivity to the trauma, which takes on a particular echo. Moreover, a trauma can test a latent psychotic structure to reveal its existence. The experience of psychosis may be traumatic in itself for patients with, notably, seclusion and sedation during hospitalization. Lastly, the symptoms of this post-traumatic psychosis will be differentiated from neurological confusion caused by a traumatic brain injury. Clinicians often fail to screen routinely for trauma and PTSD symptoms in patients with severe mental illness because few systematic guidelines exist for the identification and treatment of this comorbidity.

Conclusion

The links between psychotic and psycho-traumatic symptoms are complex and multidirectional; this co-occurrence is a factor of seriousness. The clinician, while paying attention to these symptoms, has to distinguish the structure of the personality of the subject to articulate the psychotherapy and the pharmacological treatment. Further investigational studies may determine whether antipsychotics will enhance treatment response in PTSD patients with psychotic features.     

急性创伤后应激障碍患者脑结构的磁共振研究

目的探讨单一、高强度持续刺激所致急性创伤后应激障碍(PTSD)患者早期脑部结构的变化。方法采用基于像素的形态学方法(VBM)研究受试者脑部结构变化。研究对象包括10名急性PTSD患者,10名未患PTSD的矿难幸存者,并对其PTSD症状积分(CAPS)与感兴趣区灰质密度进行相关性分析。结果与对照组相比,急性PTSD患者左侧海马前部、海马旁回和双侧距状裂皮质纹状区的灰质体积明显下降;而其白质体积未见明显变化。双侧距状裂及左侧海马灰质密度与CAPS积分存在显著负相关。结论本研究结果显示早期急性PTSD患者边缘系统的灰质体积明显减小,PTSD患者症状的严重程度与距状裂皮质纹状区和海马区的灰质密度相关。     

Risk indicators for post-traumatic stress disorder in adolescents exposed to the 5.12 Wenchuan earthquake in China

In Chinese adolescents exposed to the Wenchuan earthquake, we used the Children's Revised Impact of Event Scale (CRIES) as the screening tool, and Post-traumatic Cognitions Inventory (PTCI) and the Social Support Rating Scale (SSRS) were used to assess the cognitive status and their social supports, to evaluate the prevalence and the predictors variables of post-traumatic stress disorder (PTSD) after the Wenchuan earthquake in China, which occurred on 12 May 2008. Subjects with a CRIES score greater than 30 were interviewed and assessed using the DSM-IV criteria for PTSD diagnosis by a trained psychiatrist with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Lifetime version (Kiddie-SADS-L). We found the overall prevalence of PTSD was 2.5% in 3208 adolescents from the surrounding areas of the epicentre 6 months after the earthquake. Risk factors for post-traumatic stress symptoms are as follows: being female, being buried/injured during the earthquake, having parents who were severely injured, having classmate(s) who died, having a house destroyed, and witnessing someone buried/wounded/dying during the earthquake. Individuals with better social support had significantly lower scores on the CRIES. There were significant differences in cognitive style between individuals at low risk for PTSD (CRIES < 30) and those at high risk for PTSD (CRIES ≥ 30). Post-traumatic cognition emerged as an important factor that was associated with PTSD reactions in children. Social support can lessen the impact of a natural disaster by affecting post-traumatic cognition.     

Towards a post-traumatic subtype of obsessive-compulsive disorder

We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS.