Whiplash associated disorder: incidence and natural history over the first month for patients presenting to a UK emergency department

Objectives

To describe the epidemiology, process of care, and outcomes at 4–6 weeks after injury among patients with whiplash associated disorder attending a UK emergency department.

Methods

All patients presenting during the study period with neck pain following a road traffic accident who met the inclusion criteria were assessed. Patients were followed up with a telephone interview at 4–6 weeks after attendance using the Neck Disability Index (NDI). The patient''s general practitioner (GP) was contacted post attendance to ascertain subsequent healthcare use.

Results

A total of 200 patients were recruited to the study, of which 30 were lost to follow up. Four variables, midline tenderness (p = 0.008; 95% CI 0.9 to 6.1), x ray request (p = 0.004; 0.9 to 6.1), wearing a seat belt (p = 0.038; 0.2 to 6.2), and having seen their GP post injury (p = 0.001; CI −10.5 to 6.6), were found to be associated with a higher NDI score at follow up. Significant correlation was identified with a high pain score and an increasing age of patient and high NDI scores. No correlation was found between the impact speed, speed of vehicle struck, or time since incident with the NDI. Two thirds of patients had some disability at 4–6 weeks after injury; 91 patients (54.5%) saw their GP in the intervening period between attending the department and telephone follow up, and 87/170 patients had no idea about their prognosis.

Conclusions

This study identifies that there is significant disability associated with whiplash associated disorder. Clear prognostic information would be a useful development.     

Traumatic stressors and post-traumatic stress disorder symptoms in headache patients

OBJECTIVE: The aim of this study was to assess the prevalence of significant traumatic stressors and post-traumatic stress disorder (PTSD) symptoms in a headache population. BACKGROUND: Several recent publications have emphasized the relationship between life stressors and/or daily hassles and recurrent headaches. However, little is known about the prevalence and impact of major traumatic stressors in patients with recurrent headaches. METHODS: Eighty patients with either migraine or tension-type headache completed a PTSD checklist. Data were compared with those from patients with chronic masticatory muscle pain of similar intensity and duration. RESULTS: Almost 64% of the headache patients reported one or more major traumatic stressors. This percentage was not significantly different from that of the comparison group, and fell within the broad range reported for exposure to traumatic stressors in epidemiologic studies with nonpatient populations. One out of 6 patients in the total headache sample, and 1 out of 4 of those reporting a traumatic stressor, reported symptoms suggestive of current PTSD. The prevalence of current PTSD-like symptomatology reported by the headache patients was comparable to that of the comparison group of the present study, but higher than that reported for the general population in the available literature printed in English. Traumatic stressors most often reported were not related to direct physical trauma, but rather associated with loss or serious illness of a loved one. CONCLUSION: Exposure to traumatic events in patients with a primary diagnosis of recurrent headaches is similar to that reported for chronic masticatory muscle pain patients or nonpatient populations. However, symptoms consistent with a diagnosis of current PTSD appear to be more frequent in patients with recurrent headaches than reported in the scientific literature printed in English for nonpatient populations. Screening for PTSD symptomatology is recommended as part of the routine clinical evaluation of headache.     

国内外脑卒中病人创伤后应激障碍研究的文献计量学分析

目的:了解国内外脑卒中病人创伤后应激障碍(post-traumatic stress disorder,PTSD)相关研究的现状及存在的问题,为今后该领域的研究提供参考依据。方法:检索PubMed、中国知网、万方、维普等数据库中发表的有关脑卒中病人PTSD研究的文献,检索时间为1998年1月—2021年4月,提取文献题目、期刊名称、发表年份、文献类型、关键词、基金资助情况、第一作者等信息,采用SPSS 22.0、Nvivo 20.0等软件进行统计及文献计量学分析。结果:纳入文献49篇,随着年份的推移,发文量在逐年上升。发文机构共有41家,19篇文献有基金支持。发表文献的期刊共40种,平均每种期刊发表文献1.225篇。共有6种文献研究类型,国内和国外文献均以描述性研究为主(39篇,79.6%)。结论:国内外文献研究类型较为单一,缺少有效的干预措施缓解脑卒中病人PTSD严重程度,同时对于脑卒中病人出现PTSD的发病机制仍在探索中。未来需要更多的学者和基金支持,进行更深入的研究和探讨。     

A student-directed community project to support sexually abused women veterans suffering from post-traumatic stress disorder

While awareness of post-traumatic stress disorder (PTSD) and sexual abuse continues to grow, it has only been during the past few years that the military has realized the prevalence and impact of sexual abuse inflicted upon women while on active military duty. Though Veteran Administration (VA) agencies throughout the United States have given concerted attention to this problem, published resources specific to PTSD and military sexual abuse have been limited. In this article the authors present the results of a 2(1/2)-year endeavor to address the problem of PTSD and military sexual abuse at the Tulsa VA Outpatient Clinic. The project started with a research study and the subsequent initiation of a PTSD women veterans support group, and culminated in the development of resource manuals for both professional staff and women veterans.     

Cognitive processing of trauma cues in rape victims with post-traumatic stress disorder

Rape victims with post-traumatic stress disorder (PTSD) (n =12), rape victims without PTSD (n =12), and nontraumatized control subjects (n =12) performed a computerized Stroop color-naming task in which they named the colors of high-threat words (e.g., RAPE), moderate-threat words (e.g., CRIME), positive words (e.g., LOYAL), and neutral words (e.g., TYPICAL). In contrast to rape victims without PTSD and to nontraumatized control subjects, those with PTSD were slower to color-name high-threat words than moderate-threat, positive, and neutral words. Rape victims without PTSD nevertheless exhibited greater Stroop interference for high-threat words than did nontraumatized subjects. Interference for high-threat words was correlated with scores on the Impact of Events Scale —Intrusion subscale, but not with scores on the Avoidance subscale. These findings suggest that interference for trauma cues may provide a nonintrospective index of intrusive cognitive activity. Preparation of this article was supported, in part, by grants from the Henry and Ramsey Pevsner Fund in Neuropsychology and Behavioral Medicine and the American Association of University Women — Aurora, Illinois, Chapter awarded to Karen Lynn Cassiday, and National Institute of Mental Health grant MH43809 awarded to Richard J. McNally.This study was part of the first author's doctoral dissertation, conducted under the supervision of the second author. It was conducted when the authors were at the Department of Psychology, University of Health Sciences/The Chicago Medical School. A shorter version of this paper was presented at the annual meeting of the Association for Advancement of Behavior Therapy, San Francisco, November, 1990.     

军人创伤后应激障碍与适应障碍的视觉和听觉诱发电位研究

目的 探讨军人创伤后应激障碍和适应障碍的视觉诱发电位和听觉诱发电位的特征。方法 对33例创伤后应激障碍患者和34例适应障碍患者及30名健康军人(对照组),应用Nicolet Bravo型脑电生理仪及光、声刺激,完成视觉诱发电位和听觉诱发电位检测。结果 应激障碍组和适应障碍组Cz脑区视觉诱发电位／P2波幅较对照组为低,应激障碍组Pz脑区视觉诱发电位／P3波幅分别较对照组和适应障碍组为低;应激障碍组Oz脑区听觉诱发电位／P3潜伏期较对照组延迟,Cz脑区听觉诱发电位／P2波幅分别较对照组和适应障碍组为低,Cz脑区听觉诱发电位／P3波幅分别较对照组和适应障碍组为高。结论 应激障碍和适应障碍的诱发电位有一定的特征,值得进一步随访观察。     

Simple Educational Intervention to Improve the Recovery from Acute Whiplash: Results of a Randomized, Controlled Trial

Objectives: To determine if an educational intervention in the acute stage of whiplash injury may improve the recovery rate. Methods: Consecutive subjects were randomized to one of two treatment groups: educational intervention or usual care. The intervention group received an educational pamphlet based on the current evidence. The control group did not receive these materials but received usual emergency department care and a standard nondirected discharge information sheet. Both groups underwent follow‐up by telephone interview at two weeks and three months. The primary outcome measure of recovery was the patient's response to the question, “How well do you feel you are recovering from your injuries?” Results: A total of 112 subjects agreed to participate. Age, gender, precollision employment level and health, initial symptoms, collision parameters, and emergency treatments were similar between the groups. At two weeks postcollision, 7.3% in the treatment group reported recovery compared with 8.8% in the control group (absolute risk difference, ?1.5%; 95% confidence interval =?12.6% to 9.7%). At three months postcollision, 21.8% in the treatment group reported complete recovery compared with 21.0% in the control group (absolute risk difference, 0.8%; 95% confidence interval =?14.4% to 16.0%). At three months, there were no clinically or statistically significant differences between groups in severity of remaining symptoms, limitations in daily activities, therapy use, medications used, lost time from work, or litigation. Conclusions: An evidence‐based educational pamphlet provided to patients at discharge from the emergency department is no more effective than usual care for patients with grade 1 or 2 whiplash‐associated disorder.     

The mediating role of early maladaptive schemas on relations between post-traumatic stress disorder symptom severity and illicit substance use disorder

Background: This study examines the role of Early Maladaptive Schemas (EMS) on relations between Post-traumatic stress disorder (PTSD) symptoms and illicit substance use.

Objectives: We assumed that EMS play a mediating role in the pathways from PTSD symptom severity to illicit substance use.

Method: We used the composite score from the Addiction Severity Index to assess illicit substance use severity, the PTSD Checklist Specific to determine PTSD symptom severity, and the Young Schema Questionnaire – Short Form, Second Edition to measure the number of hyperactivated EMS. The sample consisted of 35 patients receiving social and medical care for illicit substance use problems in three French drug centers.

Results: The results showed that the number of hyperactivated EMS is an intermediate variable playing a mediating role between PTSD symptom severity and illicit substance use. Results indicating full mediation. Conclusion. Future research perspectives on this question are discussed as well as the clinical repercussions of these results on the current models of management of illicit drug users.     

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.     

Spiritual intelligence dimensions and life regard index in Iranian veterans suffering post-traumatic stress disorder with and without substance abuse history

Post-traumatic stress disorder (PTSD) among some combatants was one of the Iran–Iraq War problems. Moreover, this disorder has a high comorbidity with other kinds of disorders like substance abuse as in the case of some Iran–Iraq War veterans. This study examined the effect of some individual psychological factors on these veterans' substance abuse. Among these factors, this study seeks to find the existence of difference between spiritual intelligence and life regard index of veterans with no history of substance abuse comparing with veterans with substance abuse history. Therefore, 120 PTSD veterans hospitalized in Shahid Rajaee Hospital in Isfahan, Iran, were studied during a 9-month period. Half were with and half were without substance abuse; they were also matched on demographic characteristics. There was a significant difference between spiritual intelligence and life regard index and also spiritual life and fulfillment sub-scales of those with history of substance abuse and those without. Conversely, no significant difference was observed on sub-scales of understanding, relationship with the Origin of Essence and fulfillment. Therefore, it can be concluded that dimensions of spiritual intelligence and positive life regard development could help to deter substance abuse, as well as accelerate recovery.     

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。     

妊娠压力在产妇社会支持与产后创伤后应激障碍间的中介效应

目的:探讨妊娠压力在产妇社会支持与产后创伤后应激障碍间的作用机制,为产妇心理健康的早期筛查和干预提供参考。方法:采用便利抽样法,选取2019年11月—2020年1月上海市某三甲妇产科专科医院的1 178名进行产后检查的产妇作为研究对象,采用一般情况调查表、围生期创伤后应激障碍问卷、中文版领悟社会支持量表和妊娠压力量表对...     

创伤后应激障碍诊断与症状自评式量表的研究进展

创伤后应激障碍（PTSD）是暴露于严重创伤事件后出现的一种精神障碍,对患者个人和社会造成巨大的负担。对PTSD的早期识别是诊疗工作的关键,也是研究的热点。近年多个基于PTSD诊断标准的症状自评式量表被开发并广泛应用于PTSD的筛查和诊断。随着PTSD的诊断标准的更新和不断完善,自评式量表也经历了版本的更新换代。该文将围绕PTSD诊断标准与症状自评式量表应用的最新研究进展进行综述和归纳。     

Systematic review of factors affecting driving and motor vehicle transportation among people with autism spectrum disorder

Purpose: This systematic review is to critically appraise the literature on factors affecting driving and motor vehicle transportation experiences of people with autism spectrum disorders (ASD) and to provide insight into future directions for research. Methods: Systematic searches of eight databases identified 22 studies meeting our inclusion criteria. These studies were analysed in terms of the characteristics of the participants, methodology, results of the study and quality of the evidence. Results: Among the 22 studies, 2919 participants (364 individuals with ASD; 2555 parents of youth with ASD; mean age of person with ASD?=?17.3) were represented, across six countries. Studies (n?=?13) focused on factors affecting driving, including challenges in obtaining a licence, driving confidence, driving behaviours and strategies to improve driving skills. In regards to factors related to public and/or school transportation, nine studies explored rates of transportation use, access, cost and safety. Conclusion: Our findings highlight several gaps in the research and an urgent need for further transportation-related training and supports for people with ASD.

• Implications for rehabilitation

• Many people with ASD encounter challenges in obtaining a driver’s licence, driving confidence and driving performance compared to those without ASD.

• Several strategies can be useful when teaching people with ASD to drive including direct communication, encouraging coping mechanisms, breaking down tasks and providing regular and consistent driving lessons.

• Clinicians and educators should advocate for further transportation-related training and supports for people with ASD.

• More research is needed from the perspective of people with ASD to understand their experiences and the particular challenges that they encounter in obtaining a licence and navigating public transportation.

     

Modification of Patient Driving Behavior After Implantation of a Cardioverter Defibrillator

Driving habits among recipients of ICDs have not been well characterized previously, yet such information may have implications for development of national policy. This study was undertaken to characterize driving behavior after defibrillator implantation in our patient population. From 1988–1993, 82 ICDs were implanted at the University of Florida. All patients received defibrillator teaching preoperatively and postoperatively with particular emphasis placed on driving restrictions. A standardized questionnaire was developed to ascertain driving behavior, compliance with restrictions, and occurrence of motor vehicle accidents following implantation. The patients were divided into two groups according to whether or not they had received a shock from their device since implantation. Group I patients did, and Group II patients did not. Fifty-two out of 82 (63%, Group I) patients had at least one shock. The remaining 30 patients had received no shocks. Mean age and gender were no different between the two groups. Mean time since implantation was 6 ± 1.3 years in Group I, compared to 4 ± 1.5 years In Group II (P = 0.001). Forty-seven out of 52 (90%) and 26 out of 30 (87%) in Groups I and II, respectively, resumed driving after defibrillator implantation. There was no difference in the amount of time that passed prior to resumption of driving. Group I patients drove more, 20.5 ± 27 miles/day compared to patients in Group II, 8.3 ± 9.7 miles/day (P = 0.02). No patient experienced device discharge during driving; likewise, no patient was involved in a motor vehicle accident secondary to their device firing. Sixty-seven out of 82 (82%) patients complied with the instructions they thought they heard; seven patients in Group I and eight patients in Group II deliberately did not follow our advice. The majority of patients do comply with physician instructions, although the instructions they remember are not always the instructions given. If a national policy is created to prohibit driving after ICD implantation, effective enforcement may be difficult.     

Post-traumatic stress disorder in an emergency department population one year after Hurricane Katrina

Background

Hurricane Katrina resulted in a significant amount of injury, death, and destruction.

Study Objectives

To determine the prevalence of, and risk factors for, symptoms of post-traumatic stress disorder (PTSD) in an emergency department (ED) population, 1 year after hurricane Katrina.

Methods

Survey data including the Primary Care PTSD (PC-PTSD) screening instrument, demographic data, and questions regarding health care needs and personal loss were collected and analyzed.

Results

Seven hundred forty-seven subjects completed the survey. The PC-PTSD screen was positive in 38%. In the single variate analysis, there was a correlation with a positive PC-PTSD screen and the following: staying in New Orleans during the storm (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.28–2.34), having material losses (OR 1.64, 95% CI 1.03–2.60), experiencing the death of a loved one (OR 1.96, 95% CI 1.35–1.87), needing health care during the storm (OR 2.01, 95% CI 1.48–2.73), and not having health care needs met during the storm (OR 2.00, 95% CI 1.26–3.18) or after returning to New Orleans (OR 2.29, 95% CI 1.40–3.73). In the multivariate analysis, the death of a loved one (OR 1.87, 95% CI 1.26–2.78), being in New Orleans during the storm (OR 1.69, 95% CI 1.22–2.33), and seeking health care during the storm (OR 1.69, 95% CI 1.22–2.35) were associated with positive PC-PTSD screens.

Conclusions

There was a high prevalence of PTSD in this ED population surveyed 1 year after hurricane Katrina. By targeting high-risk patients, disaster relief teams may be able to reduce the impact of PTSD in similar populations.     

SARS患者创伤后应激障碍的随访研究

目的：探讨SARS患者创伤后应激障碍及其相关的影响因素。方法：对SARS患者采用PTSD—SS量表、社会支持量表、艾森克人格问卷分别于创伤后3个月及1年进行评定，并用CCMD—Ⅲ中有关创伤后应激障碍诊断标准进行再诊断。结果：创伤后应激障碍3个月、1年的阳性率为46．2％、38．8％，1年内累积阳性率为55、2％。相关的影响因素有职业、精神质、主观支持和对支持的利用度。结论：健全患者人格，使患者获得更多的社会支持，可降低创伤后应激障碍发生的危险。     

汶川地震两年后重灾区护士创伤后应激障碍症状分析及干预对策

目的 调查分析“5.12”汶川地震2年后重灾区护士创伤后应激障碍(PTSD)的发生情况、症状特点和相关因素,并探讨有效的心理干预对策.方法 采用便利抽样,以绵竹重灾区5家医院233名参与过救援的护士为调查对象,采用自制的震后基本状况调查表、PTSD检查量表平民版(PTSD checklist-civilian version,PCL-C)进行调查.结果 震后2年护士PTSD筛查阳性率为1.7％,另有8.2％的人表现出不同程度的创伤后应激障碍症状;PTSD的特征性症状群中,最突出的为高警觉性症状;年龄36～57岁(中年)、职称为主管护师、离异或丧偶者、健康状况差、地震中受过伤的护士群体,其PTSD检出率较高;健康状况差、离异或丧偶为2年后护士PTSD症状的主要相关危险因素.结论 震后2年护理人员仍存在一定程度的PTSD,且具有其自身的特点,需引起关注,采取针对性的心理干预.     

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.