The acute stress disorder in the paediatric surgical children and adolescents injured in the Wenchuan earthquake of China

The aim of the present study was to investigate the prevalence and the symptoms of acute stress disorder (ASD) in the paediatric surgical children and adolescents injured in the Wenchuan earthquake of China. One hundred and eighteen children and adolescent inpatients were surveyed by the Acute Stress Disorder Scale (ASDS) within 1 month of the earthquake. Using the validated ASDS score above cut‐off threshold levels, the incidence of ASD in this sample was 54.3 per cent. The morbidity of ASD were 56.1, 24.6 and 19.3 per cent in the child group, in the early adolescent group and in the middle adolescent group, respectively. There was no significant difference among the three age groups about the severity of ASD symptom. The proportions of ASD‐positive were 44.0 per cent in males and 63.6 per cent in females that showed significant difference. The exposure risk factors were being buried in the earthquake, injury of parent, injury of relatives, amputation and operation. These results indicated that ASD was widely prevalent among the children and adolescents wounded in the earthquake, which needed an effective psychosocial intervention. Copyright © 2009 John Wiley & Sons, Ltd.     

脑卒中患者急性应激障碍及影响因素研究

目的探讨脑卒中患者急性应激障碍发生现状及影响因素。方法采用斯坦福急性应激反应问卷对349例脑卒中住院患者进行调查。结果共163例(46.70%)患者发生急性应激障碍;Logistic回归分析结果显示,患者性格、是否存在偏瘫及是否吞咽功能障碍是脑卒中患者发生急性应激障碍的主要影响因素(P0.05,P0.01)。结论脑卒中患者急性应激障碍发生率较高,内向性格及存在偏瘫和吞咽功能障碍的患者更容易发生急性应激障碍。医护人员应及时为高危患者提供个体化治疗及预见性护理,防止脑卒中患者发生急性应激障碍。     

Acute stress disorder and posttraumatic stress disorder in parents of injured children

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) were examined in 334 parents of children with traffic‐related injuries. In the first month after their child's injury, 12% of parents had ASD and another 25% had partial ASD. Among 251 parents assessed again approximately 6 months postinjury, 8% had PTSD and another 7% had partial PTSD. The ASD and PTSD severity were associated (r = .54), but ASD status was not a sensitive predictor of later PTSD. Independent predictors of ASD severity included prior trauma exposure, peritrauma exposure and perceptions of the child's pain and life threat, and child ASD severity. Independent predictors of PTSD severity included prior trauma exposure, parent ASD severity, and parent‐rated child physical health at follow‐up.     

Impact of paediatric surgery training on the attitudes and experience of frontline general surgeons in common paediatric surgical emergencies

Aim: The present study is a survey of the attitudes and experience of frontline general surgeons in common paediatric surgical emergencies, and their exposure to paediatric surgery (PS) during training. Methods: Questionnaires were sent to higher trainees and junior specialists in general surgery. Their experience in the management of common paediatric emergency conditions including acute scrotum, toddler appendicitis, infant incarcerated inguinal hernia and intussusception was asked. Results: Of the surgeons, 60.8% and 41.2% had no exposure to PS in their internship and basic surgical training, respectively. The majority of them managed less than five cases of intussusception (82.4%) and incarcerated inguinal hernia (66.7%); 19.6% and 37.3% indicated that they were competent in managing intussusception and incarcerated inguinal hernia, respectively. The majority believed that general surgeons should know how to manage these common paediatric emergency conditions. However, 56.9% and 78.4% opined that infants with incarcerated inguinal hernia and intussusception, respectively, should be managed in paediatric surgical centres. Conclusions: Although most frontline general surgeons opined that they should know how to manage common paediatric surgical emergencies, the majority of them did not feel competent to manage infantile intussusception and incarcerated inguinal hernia due to inadequate clinical exposure. They believed that intussusception and incarcerated inguinal hernia should be managed in a paediatric surgical centre.     

Symptoms of posttraumatic stress disorder, depression, and anxiety among adolescents following the 2008 Wenchuan earthquake in China

This study examined the symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression among 2,250 adolescents 6 months after the 2008 Wenchuan earthquake in China. Results showed that 15.8%, 40.5%, and 24.5% of participants reported clinical symptoms of PTSD, anxiety, and depression, respectively. Posttraumatic stress disorder, anxiety, and depression were highly comorbid. Risk factors for symptoms of the 3 disorders were female gender, older age, and earthquake disaster exposure. In addition, the interaction effects of residence (urban/rural) and number of siblings of study subjects on symptoms of the 3 disorders were examined. Implications of findings on intervention and prevention of mental health problems among adolescents after experiencing earthquake disasters are discussed.     

Post-traumatic stress disorder among the injured of theintifada

The current study aimed to assess the prevalence of PTSD among Palestinians who sustained serious bodily injuries during theintifada, as well as to delineate factors having an effect on the development and attenuation of PTSD symptomatology. Results indicated evidence of high prevalence of PTSD among the injured. No significant differences in PTSD prevalence for demographic, situational, and trauma-related variables were found except for the age factor. Prevalence of PTSD among adolescents was significantly higher than among adults. It seemed that the injury itself was so intensely overwhelming that the other variables were overshadowed. Implications for further research and stress management techniques were discussed.     

Epidural sufentanil during paediatric cardiac surgery: effects on metabolic response and postoperative outcome

The metabolic and neuroendocrine effects of caudal epidural analgesia were studied during paediatric cardiac surgery. Combined epidural and general anaesthesia (EPI group; n=12) was compared with deep opioid anaesthesia (DOA group; n=12). During anaesthesia and surgery, haemodynamic stability was similar in the two groups. There was no significant difference between groups concerning the metabolic response to surgery but circulating catecholamines were significantly lower in the EPI group during and after surgery. Perioperative release of IL-6 was higher in the EPI group possibly reflecting a longer aortic clamp time. Incidence of postoperative life-threatening dysrhythmias was very low in the two groups. No significant reduction of postoperative mechanical ventilation, intensive care unit or hospital stays was reported with epidural analgesia. The incidence of postoperative infections was higher than expected in the two groups because of the poor properative clinical status of most of the children included in the study.     

Postoperative complications and their association with post-traumatic stress disorder in academic vascular surgeons

ObjectivesPostoperative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons.MethodsAn anonymous electronic survey was sent to all vascular surgery program directors in North America with a request to disseminate to their faculty. The survey captured data on demographics and practice type and used imbedded validated measures to determine emotional responses to postoperative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Multivariable logistic regression analysis was performed for all covariates found significant on univariate analysis, and those deemed clinically relevant.ResultsThe survey was distributed to 267 faculty at 128 institutions in the United States and 10 institutions in Canada and completed by 65 participants (response rate, 32%). Twenty of 65 (31%) identified as female, and the total group had a mean age of 47 ± 10.2 years. Most respondents (43/65; 66%) reported a major complication within 3 months of the survey, with the majority of respondents (45/65; 69%) reporting the outcome of patient mortality. Of respondents, 20 of 65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year, with 12 of 65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to criticize/blame themselves following the complication (P = .0028); less likely to identify the complication as “expected” (P = .048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs 20%; P = .008). Regarding support following major complications, most respondents (57/65; 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and a sense of honor (66%). Gender differences persisted on multivariate analysis (P = .016).ConclusionsEmotional responses following major postoperative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly following complications that are unexpected or in cases in which the cause of the complication was due to a perceived or actual surgical mistake. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described and under-recognized. Gender-related differences may exist, and most surgeons desire a support network of respected peers with whom to discuss complications.     

The relationship between acute stress disorder and posttraumatic stress disorder in injured children

This study indexed the relationship between acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) in injured children. Consecutive children between 7-13 years admitted to a hospital after traumatic injury (n = 76) were assessed for ASD. Children were followed up 6-months posttrauma (n = 62), and administered the PTSD Reaction Index. Acute stress disorder was diagnosed in 10% of patients, and 13% satisfied criteria for PTSD. At 6-months posttrauma, PTSD was diagnosed in 25% of patients who were diagnosed with ASD. Acute stress reactions that did not include dissociation provided better prediction of PTSD than full ASD criteria. These findings suggest that the current ASD diagnosis is not optimal in identifying younger children who are high risk for PTSD development.     

When disaster strikes,acute stress disorder may follow

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.     

Post-traumatic stress disorder and the MMPI-2

This study compared the MMPI-2 profiles of 27 veterans diagnosed with post-traumatic stress disorder with a non-PTSD comparison group of 27 veteran patients receiving inpatient treatment for other mental disorders. Three multivariate analyses of variance were conducted comparing the two groups on the 10 traditional clinical scales, the 12 supplemental scales and the 15 new content scales on the MMPI-2. The PTSD group obtained a mean profile with peak elevations on the F validity scale and on clinical Scales 2 (D) and 8 (Sc). The multivariate analysis of variance comparing the PTSD and non-PTSD groups across the 10 traditional clinical scales was not significant. The multivariate analyses of variance comparing the two groups on the 12 supplemental scales and the 15 content scales were significant. Significant univariate supplemental scale differences were found on the Keane PTSD scale (PK) and the Post-Traumatic Stress Disorder (PS) scale with the PTSD group scoring higher on PK and PS. Significant univariate content scale differences were found for the Anger (ANG) scale with the PTSD group scoring higher. A cut-off score of 28 on the PK scale correctly classified 76% of the overall sample, 67% of the PTSD group and 85% of the non-PTSD-comparison group.     

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.     

Post-traumatic stress disorder, anxiety and depression among the elderly: a survey of the hard-hit areas a year after the Wenchuan earthquake

Few studies to date have examined psychological sequelae of natural disasters among the elderly in China. The aim of this study was to investigate the prevalence rates of probable post-traumatic stress disorder (PTSD), anxiety and depression in the elderly survivors a year after the Wenchuan earthquake as well as to analyse related risk factors. The community-based sample of the study consisted of 284 elderly survivors (≥60 years). PTSD was assessed by the PTSD Checklist--Civilian version, and anxiety and depression were assessed by the Hopkins Symptoms Checklist. In total, the estimated prevalence rates of probable PTSD, anxiety and depression were 26.3%, 42.9% and 35.2%, respectively. Nearly a fifth of the elderly participants reported symptoms that meet the criteria for all three of these mental disorders. Results indicated that some factors associated with earthquake-exposure intensity, which included loss of livelihood, bereavement, injury and initial fear during the earthquake, were among the significant risk factors for these mental disorders. Women had a higher risk of suffering from probable anxiety as compared to men. Finally, the significance and limitations of this study were also discussed.     

Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery

BackgroundAfter bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S.ObjectiveOur study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S.SettingTeaching hospital and surgical weight loss center in the United States.MethodsA total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189).ResultsAfter accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR² = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR² = .12 and .13, respectively; overall model R² =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms.ConclusionsOver and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.     

Cardiorespiratory changes during laparoscopic fundoplication in children

The results of a prospective assessment of cardiorespiratory changes related to anaesthesia and laparoscopic Nissen fundoplication are described in 25 children aged 1.2 to 14.3 years, weighing 9.0 to 64.0 kg. Respiratory disease or oesophagitis were present in 68% cases. During balanced inhalational anaesthesia, hypotension or bradycardia occurred prior to peritoneal insufflation in three cases of reverse Trendelenburg position. During surgery, intra-abdominal pressure was in the 6–10 mmHg range. Transiently, two patients were hypotensive while ten were hypertensive. PETCO₂ gradually increased but only two patients required increased minute ventilation. One bronchial intubation episode developed. Airway complications were related to isoflurane administration. Postoperatively, transient hypoxia (25% cases) was observed during the first 3 h. Analgesia duration was in the 40–1440 min range. Hospital stay was 5.6 ± 1.5 days (mean ± SD). Laparoscopic paediatric fundoplication is safe when hypovolaemia and postoperative hypoxia are prevented.     

Comparison of the posttraumatic stress disorder scale versus the clinician-administered posttraumatic stress disorder scale in domestic violence survivors

The posttraumatic diagnostic scale (PDS) is a self-report instrument for PTSD that is simple to administer and has demonstrated good psychometric properties. We compared the PDS with the gold standard clinician administered PTSD scale (CAPS) diagnostic interview for PTSD. We assessed 138 women who were victims of domestic violence using both the PDS and the CAPS. Findings confirmed that PTSD develops at a high base rate in this sample. The PDS generally performed well in relation to the CAPS although with a tendency to overdiagnose PTSD. The findings lend further support to the use of the PDS as a diagnostic tool for PTSD but indicate that it is better at identifying survivors with PTSD than those without the disorder.     

肾脏替代治疗对挤压综合征伤口的影响分析:汶川地震经验总结

[目的]分析肾脏替代治疗对挤压综合征患者伤口的影响,为今后治疗挤压综合征以及制定治疗策略提供更好的临床依据。[方法]收集汶川地震中本院收治的挤压综合征患者临床资料和相关治疗结果,将入选的患者分成肾脏替代治疗组和非肾脏替代治疗组,对比分析伤口感染率、伤口活动性动脉出血发生率、小腿减压切口渗液量的差异。[结果]肾脏替代治疗组和非肾脏替代治疗的伤口感染率差异有统计学意义(P=0.006)。肾脏替代治疗组培养出的致病菌前3位依次是不动杆菌属、铜绿假单胞菌和肠杆菌属,为多重耐药菌株。肾脏替代治疗组创面渗液量显著高于非肾脏替代治疗组(P=0.000)。[结论]肾脏替代治疗易导致挤压综合征患者开放创面渗液量增多、感染率高以及多重耐药菌株混合感染。     

Four different fluid regimes during and after minor paediatric surgery—a study of blood glucose concentrations

In order to evaluate the efficiency of glucose homeostatic mechanisms in otherwise healthy infants and children during and after anaesthesia and surgery four different fluid regimes were studied in 40 patients, 6–24 months old. The four regimes all resulted in a total fluid volume of 10 ml·kg^?1·h^?1 intraoperatively and 3 ml·kg^?1 h^?1 postoperatively. One group received a combination of glucose 300 mg·kg^?1h^?1 and Ringer acetate intraoperatively and glucose postoperatively, a second group was given the same intraoperative fluid followed by glucose free Ringer acetate postoperatively. A third group received Ringer acetate both intra- and postoperatively and a fourth group was given Ringer acetate intraoperatively and glucose postoperatively. Blood glucose concentrations were measured after induction (Preop.), immediately after surgery (Postop.) and after 30, 60 and 120 min. Increased blood glucose concentrations were found in all children immediately after surgery. The concentrations were highest among children given glucose. Postoperatively blood glucose remained elevated in children receiving glucose after surgery. In patients without postoperative glucose supply blood glucose concentrations declined. Hypoglycaemia was not seen on any occasion. The differences in blood glucose concentrations with different regimes were significant but small. We conclude that the studied group of healthy children appeared to be capable of regulating blood glucose levels within normal limits with or without intraoperative glucose and also if the intraoperative glucose supply was interrupted postoperatively.     

Lithium for irritability in Post-Traumatic stress disorder

Irritability is often a problem for patients with Post-Traumatic Stress Disorder (PTSD). We describe two cases that illustrate the use of lithium in the treatment of veterans with PTSD who complained of serious problems with irritability or angry outbursts. These cases are discussed in the context of evidence that lithium may be useful in other patients with disorders of impulse control. The evidence linking disorders of anger and impulse control to a dysregulation in neurotransmitter regulation, particularly in serotonergic pathways, supports a psychopharmacologic approach to treatment. These findings should lead to further study of the role of lithium in the treatment of this symptom complex in patients with PTSD.