Predictors of Acute Stress Following Motor Vehicle Accidents

The aim of this study was to investigate the predictors of acute stress following motor vehicle accidents (MVA). Sixty-two consecutive adult admissions to a hospital were assessed between two days and four weeks following a MVA. Participants were assessed for acute stress disorder (ASD) with a structured clinical interview and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. The prevalences of full and sub-syndromal ASD were 16.1% and 14.5%, respectively. BDI, history of psychiatric treatment, history of posttraumatic stress disorder (PTSD), and history of previous MVA accounted for 61% of the variance of acute stress severity. The findings indicate that predictors of acute stress severity are comparable to the predictors of PTSD and highlight the possibility of identifying those who may benefit from early treatment.     

Predictors of Acute and Posttraumatic Stress Symptoms in Parents Following Their Child's Cancer Diagnosis

This longitudinal study aimed to examine acute and posttraumatic stress symptoms and predictors of traumatic stress symptoms in parents of children recently diagnosed with cancer. The sample comprised 220 parents of 143 children who completed questionnaires at diagnosis (T1) focused on acute stress disorder (ASD); of these, 145 parents of 97 children completed questionnaires 6–8 months later (T2) focused on posttraumatic stress disorder (PTSD). Demographic, psychosocial, and treatment and illness variables were predictors. Results were that 63% of mothers and 60% of fathers met criteria for ASD at T1. At T2, 21% of mothers and 16% of fathers met criteria for PTSD, with 40% of parents reporting significant subthreshold symptoms. Predictors of ASD symptoms were female gender, presence of psychosocial risk factors, trait anxiety, family functioning, and central nervous system tumor diagnosis. Risk factors for PTSD symptoms were younger maternal age, severity of ASD symptoms, and trait anxiety at T1, and parent‐reported quality of life of the child at T2. The results suggest that screening for ASD may help identify parents at increased risk of persistent traumatic stress symptoms who could benefit from preventative, evidence‐based psychosocial interventions.     

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.     

The influence of traumatic brain injury on acute stress disorder and post-traumatic stress disorder following motor vehicle accidents

This study compared the acute stress disorder and post traumatic stress disorder PTSD symptom profiles in motor vehicle accident survivors who sustained a mild traumatic brain injury MTBI or no TBI. Consecutive adult patients who sustained a MTBI n=79 and no TBI n=92 were assessed for acute stress disorder within 1 month of their trauma and reassessed for PTSD MTBI: n=63; non TBI; n=72 6 months post trauma. Comparable rates of acute stress disorder and PTSD were reported in MTBI and non TBI patients. Intrusive memories and fear and helplessness in response to the trauma were reported less frequently by MTBI than non TBI patients at the acute phase. Six months post trauma fewer MTBI patients than non TBI reported fear and helplessness in response to the trauma. These findings suggest that, whereas impaired consciousness at the time of a trauma may reduce the frequency of traumatic memories in the initial month post trauma, MTBI does not result in a different profile of longer term PTSD.     

Mild Traumatic Brain Injury Does not Produce Post-Traumatic Stress Disorder

It has been widely assumed that patients who sustain mild traumatic brain injury (MTBI) or post-concussive syndrome develop post-traumatic stress disorder (PTSD) in response to their cognitive difficulties, diminished coping skills, or other losses. This study examined 70 patients who had previously been diagnosed as having either PTSD or MTBI. Each patient was asked to provide a highly detailed chronological history of the events which preceded, followed, and occurred during the traumatic event, to indicate whether they were rendered unconscious or had amnesia for the event, and to describe the various symptoms they developed. All (100.0%) of the PTSD patients were able to provide a highly detailed and emotionally charged recollection of the events which occurred within 15 minutes of the traumatic event in comparison to none (0.0%) of the MTBI patients. None of the MTBI patients reported symptoms such as intrusive recollections of the traumatic event, nightmares, hypervigilance, phobic or startle reactions, or became upset when they were asked to describe the traumatic event or were exposed to stimuli associated with it. These data suggest that PTSD and MTBI are two mutually exclusive disorders, and that it is highly unlikely that MTBI patients develop PTSD symptoms. Furthermore, these findings suggest that clinicians should exercise considerable caution in ruling out PTSD prior to making the diagnosis of MTBI.     

Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury

PRIMARY OBJECTIVE: To investigate the relation between psychosocial functioning (community integration, life satisfaction and social support) and symptoms (post-concussion, post-traumatic stress and depression) in persons with mild traumatic brain injury (MTBI) 3 years after the trauma. METHODS: Population-based follow-up study of 163 patients. At follow-up, an assessment of community integration, social support, life satisfaction and symptoms was made. RESULTS: Total score of Community Integration Questionnaire (CIQ) was negatively correlated to total score of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ, r = -0.270, p < 0.001) and to total score of the Beck Depression Inventory (BDI, r = -0.332, p < 0.001). Life satisfaction (LiSat-11) was negatively correlated to the RPQ (r = -0.459, p < 0.001), to total score of the Impact of Event Scale (IES, r = -0.365, p < 0.001) and to the BDI (r = -0.642, p < 0.001). Low levels of life satisfaction were common at follow-up. CONCLUSIONS: A large proportion of the individuals with MTBI experienced both psychosocial difficulties, with low levels of life satisfaction in particular and symptoms (post-concussion, post-traumatic stress and depression) 3 years after trauma. Since the possibility of pre-injury factors contributing to the condition at follow-up cannot be ruled out, the study indicates that all these factors should be taken into consideration in the management of persons with MTBI.     

Incidence of and risk factors for acute stress disorder in children with injuries

BACKGROUND: To assess the incidence of and risk factors for Acute Stress Disorder (ASD) in children with injuries. Numerous studies have documented the increased incidence of PTSD in those initially diagnosed with ASD. PTSD symptoms cause tremendous morbidity and may persist for many years in some children. METHODS: Children hospitalized with one or more injuries were interviewed and assessed with the following: Child Stress Disorders Checklist (CSDC), Family Strains Scale, Brief Symptom Inventory (BSI) and Facial Pain Scale. RESULTS: Participants included sixty-five children (ages 7-18 years). The mechanisms of injury varied (e.g. MVC, penetrating). The mean injury severity score was 8.9 +/- 7. The mean length of hospital stay was 4.6 +/- 4.6 days. Altogether, 18 (27.7%) of participants met DSM IV criteria for ASD during their acute hospital stay. Risk factors such as level of family stress, caregiver stress, child's experience of pain, and child's age were predictive of acute stress symptoms. CONCLUSION: We have identified four risk factors of ASD that have implications for the treatment, and possibly, preventative intervention for PTSD. Further investigation and greater understanding of risk factors for ASD in children with injuries may facilitate the design of acute interventions to prevent the long-term negative outcomes of traumatic events.     

Correlates of acute stress disorder in cancer patients

This study investigated the correlates of acute stress disorder (ASD) following a diagnosis of cancer. Adults diagnosed with first onset head, neck, or lung malignancy (N = 82) were assessed within one month of diagnosis using the ASD Interview, and the Structured Clinical Interview for DSM-IV to index the incidence of ASD and other affective disorders following their cancer diagnosis. Participants were also administered questionnaires that assessed dissociative symptoms, coping strategies, and quality of life. Acute stress disorder was diagnosed in 28% of participants. Acute stress disorder severity was associated with gender, elevated dissociative responses, trait anxiety, and preoccupation with one's diagnosis, and a decline in cognitive functioning. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance.     

A diagnostic interview for acute stress disorder for children and adolescents

The goal of this study was to develop a semistructured clinical interview for assessing acute stress disorder (ASD) in youth and test its psychometric properties. Youth (N = 168) with an acute burn or injury were administered the acute stress disorder module of the Diagnostic Interview for Children and Adolescents (DICA‐ASD). The DICA‐ASD demonstrated strong psychometric properties, including high internal consistency (α = .97) and perfect diagnostic interrater agreement (κ = 1.00). Participants diagnosed with ASD scored significantly higher than those not diagnosed on validated traumatic stress symptomatology measures but not on other symptomatology measures, providing evidence of convergent and discriminant validity. Preliminary evidence supports the reliability and validity of the first semistructured clinical interview for diagnosing ASD in youth.     

Factors predicting return to work following mild traumatic brain injury: a discriminant analysis

Studies of mild traumatic brain injury (MTBI) suggest that most individuals recover rapidly and return to their everyday activities. However, a percentage of MTBI patients report persistent problems with cognitive, physical, and emotional symptoms. There is also evidence that some experience changes in occupational functioning following MTBI. The current study used a stepwise discriminant function analysis (DFA) to examine the role of injury severity variables, cognitive performance, and ratings of symptoms of TBI in predicting work status following MTBI. Subjects included 121 MTBI patients who were all active-duty military personnel. The stepwise DFA revealed that age and three cognitive variables (verbal memory, verbal fluency, and a speed test of planning and strategy) were predictive of work status 3-15 months following a documented MTBI, correctly classifying work status 68.8% of the time. A cross-validation DFA was conducted, with a 66.1% correct classification rate. These findings highlight the importance of cognitive impairments in identifying those at risk for occupational impairment following MTBI.     

The Acute Stress Checklist for Children (ASC-Kids): development of a child self-report measure

This project aimed to develop and validate a brief, practical self-report measure of acute stress disorder (ASD) reactions (including ASD diagnostic criteria) in children and adolescents. A draft measure was reviewed for content validity by an expert panel, piloted with youth, and revised for clarity and coverage of key constructs. The new 29-item Acute Stress Checklist for Children (ASC-Kids) was administered to 176 youth age 8 to 17 who had a recent injury or intensive care unit admission. The ASC-Kids demonstrated strong test-retest reliability and internal consistency, as well as concurrent and predictive validity with other traumatic stress measures. Results of exploratory factor analyses were consistent with current conceptualizations of acute traumatic stress reactions. The ASC-Kids is a promising measure of child acute stress reactions.     

腹腔镜胆囊切除术中胆管损伤的调查分析

目的 调查分析腹腔镜胆囊切除术(LC)中引起胆管损伤的原因和损伤后的处理方法.方法 对广东省内10家大型三甲医院所发生的和收治外院转入的LC胆管损伤病例进行调查,获得自1993年10月至2007年11月发生的LC胆管损伤病例110例,对病例数据进行统计学分析.结果 110例LC胆管损伤病例中,在该10家大型医院内发生者58例(52.7%),而在外院损伤后转入者52例(47.3%).损伤原因包括:(1)经验不足(48.2%);(2)胆囊急性炎症期进行手术(20.0%);(3)Calot 三角结构不清(15.5%)和解剖变异(11.8%);(4)术中出血导致损伤(4.5%).损伤部位主要在胆总管和肝总管.106例接受且H管修复手术或内镜下放置胆管支架,术后恢复良好率达95.3%,病死率为0.9%,有3.8%的病例手术后仍有胆管炎发作.有63例患者采用胆管空肠吻合手术治疗,术后恢复良好率达93.7%;修复手术在损伤后30 d内实施的占63.2%;83.0%的病例一次手术修复成功.结论 经验不足和解剖不清等主观因素是LC术中胆管损伤的主要原因;LC术中胆管损伤的修复需要由有胆管修复经验的肝胆外科医牛进行,及时转诊可以使患者获得良好的疗效.早期进行修复是可行的.     

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.     

The relationship between sexual abuse and mild traumatic brain injury

It remains unclear why some individuals with mild traumatic brain injury (MTBI) complain of cognitive deficits many months after the injury. Given neuropathological changes associated with prolonged stress, such as occurs with repeated sexual abuse (SA), it seems possible that individuals who experienced SA might be predisposed to greater deficits after MTBI. Four groups of subjects were administered measures of cognitive and emotional functioning. These groups were those with MTBI (n = 10), those with a history of SA (n = 10), those with both MTBI and SA (n = 10), and normal control NC subjects (n = 10). Copared to the NC subjects, those with MTBI demonstrated deficits in working memory, those with SA demonstrated deficits in executive functioning, and those with both MTBI and SA demonstrated the greatest number of deficits which were in working memory, executive functioning and memory. Tests of anxiety, depression and post traumatic stress disorder, while demonstrating significant symptoms in all clinical groups, did not correlate with the neuropsy chological tests that differentiated the groups.     

Dissociative Symptoms in Acute Stress Disorder

This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.     

The symptom checklist-90-revised and mild traumatic brain injury

OBJECTIVE: Assessment of emotional functioning is a critical aspect of the clinical neuropsychological evaluation of individuals following mild traumatic brain injury (MTBI). The objective of this study was to examine the utility of the Symptom Checklist-90-Revised as a brief tool for assessing psychological and symptomatic distress following MTBI. METHOD: A contrasted groups approach, involving three clinical groups (MTBI, Whiplash Associated Disorder, Type I Diabetes) and a non-clinical control group, was used in this study. RESULTS: The group with MTBI scored significantly higher on the majority of primary symptom dimensions and global distress indices of the SCL-90-R compared to both the diabetes and non-clinical control groups. Analysis of individual cases further revealed that 68.2% of the participants in the group with MTBI were classified as positive cases, a rate significantly higher than that of the diabetes and non-clinical control groups. The group with MTBI did not differ significantly from the group of individuals with whiplash associated disorder with respect to elevation of primary symptom dimensions or global distress indices, or the number of cases classified as positive. CONCLUSION: The results of this study suggest that the SCL-90-R has considerable utility as a general measure of psychological and symptomatic distress following MTBI.     

The role of panic attacks in acute stress disorder in children

This study examined the role of peritraumatic panic symptoms during trauma in childhood acute stress. Children (N = 60) who had suffered traumatic injury were administered the Child Acute Stress Reaction Questionnaire, the Child Depression Inventory, and the Physical Reactions Scale to index panic attacks that occurred during the trauma. Panic attacks were experienced during their trauma by 100% of participants with acute stress reactions and 24% of participants without stress reactions. Panic attacks during trauma accounted for 28% of the variance of acute stress reactions, with an additional variance accounted for by age, time since the accident, and dysphoria. These findings are discussed in terms of fear conditioning models of posttraumatic stress.     

Effects of acute injury characteristics on neuropsychological status and vocational outcome following mild traumatic brain injury

Despite recent attempts to define acute injury characteristics of mild traumatic brain injury (MTBI), neuropsychological outcome is often unpredictable. One hundred MTBI cases were prospectively collected, which were consecutive referrals to a concussion clinic, and the roles of various acute neurologic variables were examined in relation to neuropsychological status and vocational outcome. Significant differences were found between subgroups of patients classified by (1) mechanism of injury (i.e. acceleration/deceleration trauma in which the head strikes an object (HSO) versus acceleration/ deceleration trauma in which the head does not strike an object (HNSO) versus trauma in which an object strikes the head (OSH), and (2) type of injury (i.e. motor vehicle collision, fall, assault, motor vehicle-pedestrian collision, falling object, sports/recreation). There was no difference, with respect to neuropsychological status or vocational outcome, between patients who had positive findings on computerized tomography (CT) versus those who were CT negative. Additionally, there was no difference between patients who had suffered brief loss of consciousness (LOC) and those without LOC. These findings suggest that selective acute injury characteristics may be used to classify subtypes of MTBI patients.     

A retrospective study of ketamine administration and the development of acute or post‐traumatic stress disorder in 274 war‐wounded soldiers

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post‐traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010–2012). The diagnosis of post‐traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post‐traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post‐traumatic stress disorder and 89 (32%) had received ketamine. Fifty‐four patients (55%) in the post‐traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3–13 [1–26]) vs. 3 (2–4 [1–6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post‐traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post‐traumatic stress disorder in the military trauma setting.     

Interaction of posttraumatic stress disorder and chronic pain following traumatic brain injury

OBJECTIVE: To investigate the association between posttraumatic stress disorder (PTSD) and chronic pain in patients who had sustained a severe traumatic brain injury (TBI). DESIGN: Correlational relationships between pain variables and PTSD measures were examined in a cohort study. SETTING: An adult tertiary care center brain injury clinic. PATIENTS: Ninety-six persons with severe TBI. OUTCOME MEASURES: The Posttraumatic Stress Disorder Interview (PTSD-I), a modified McGill Pain Questionnaire, the Beck Depression Inventory (BDI), the General Health Questionnaire (GHQ), the Community Integration Questionnaire (CIQ), the Satisfaction with Life Scale (SWL), and the Coping Style Questionnaire (CSQ). RESULTS: More persons with chronic pain reported PTSD than did those without pain. The relationship between pain severity and depression, functional adjustment, and satisfaction with life was mediated by severity of PTSD. Pain severity was significantly associated with an avoidant coping style. CONCLUSIONS: Effective rehabilitation of persons with chronic pain following severe TBI should recognize the role of posttraumatic stress in the maintenance of dysfunctional reactions. Specific interventions that address adaptive coping mechanisms to reduce PTSD may enhance rehabilitation for persons with TBI who suffer chronic pain.