大地震创伤后应激障碍患者的心理与神经内分泌变化

目的 :研究唐山大地震所致慢性创伤后应激障碍患者基础血清皮质醇浓度和地塞米松抑制试验。方法 :唐山大地震所致创伤后应激障碍 3 5例 (研究组 )和 3 3例正常人 (对照组 )接受了基础血清皮质醇水平的测定和地塞米松抑制试验。结果 :两组基础血清皮质醇水平比较差异无统计学显著性 ,各组男女之间基础血清皮质醇水平分别比较差异亦无统计学显著性。两组服用相同剂量的地塞米松后 ,研究组血清皮质醇水平低于对照组和对血清皮质醇的抑制作用高于对照组 ,差异均有统计学显著性。各组男女之间的基础血清皮质醇水平、服用地塞米松后血清皮质醇水平和对地塞米松的抑制率比较差异无统计学显著性。结论 :唐山大地震所致慢性PTSD患者对糖皮质激素的敏感性增高而导致PHA轴负反馈抑制增强 ,无性别差异     

创伤后应激障碍的研究进展

本文主要综述了创伤后应激障碍的概念,影响因素及干预措施。     

车祸事件后创伤后应激障碍的研究

目的 :研究车祸事件后创伤后应激障碍的发生情况及特点。方法 :应用中国精神疾病分类方案与诊断标准第二版修订本中的急性应激障碍 (ASR)和创伤后应激障碍 (PTSD)诊断标准 ,对因车祸住我院治疗的 81例患者进行诊断 ,采用症状自评量表 (SCL -90 ) ,艾森克个性问卷 (EPQ)及症状记录表等进行测评。结果 :车祸后 3个月 ,81例中有 33例 ( 4 0 7%)曾经符合ASR诊断标准 ,31例 ( 38 3%)符合PTSD诊断标准。与非PTSD组比较 ,PTSD组SCL -90总分、总均分、阳性项目数、阴性项目数及躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、其它因子分均显著高于非PTSD组 (P <0 0 5～ 0 0 1)。PTSD组情绪稳定度倾向不稳定型 ( 38 71%)的比率高于非PTSD组 (P <0 0 1)。与PTSD发病有关的影响因素为EPQ问卷中神经质、L量表及性别。结论 :车祸事件后PTSD并非罕见 ,与性别及个性心理特征有关。     

癌症患者创伤后应激障碍症状特点及社会心理相关因素

目的研究癌症患者创伤后应激障碍(PTSD)症状特点及社会心理相关因素。方法采用PTSD筛查量表、社会支持评定量表、简易应对方式量表、艾森克人格量表对198例癌症患者进行问卷调查。结果①有20%的癌症患者PTSD筛查量表3个分量表均分大于3;②不同居住地被试PTSD症状有显著差异,农村显著高于城市(t=2.240,P<0.05);③不同癌症类型被试PTSD症状有显著差异,乳腺癌和子宫癌患者要显著低于其他类型的癌症(F=2.313,P<0.05);④不同患病时间被试PTSD症状有显著差异,随着时间推移有上升的趋势(F=2.389,2.626,2.418;P<0.05);⑤癌症患者PTSD症状与消极应对、精神质、神经质成正相关(P<0.05),与积极应对、社会支持成负相关(P<0.05)。结论有20%癌症患者的各类症状达到中度以上的水平,居住在农村的癌症患者PTSD症状更严重、乳腺癌和子宫癌患者的症状更少、随着时间推移癌症患者PTSD症状更严重。人格特征、应对方式、社会支持是影响癌症患者PTSD的重要因素。     

创伤后应激障碍患者创伤后应激症状与自传体记忆过度概括化的相关

目的:探讨伤后应激障碍患者的创伤后应激障碍症状与过度概括化自传体记忆的相互关系。方法:选取符合入组条件的创伤后应激障碍患者30人,正常对照组30人,所有被试均接受自传体记忆(AMT)、创伤后应激障碍症状自评量表(PTSD-SS)测验。结果:1与正常对照组比较,PTSD患者PTSD症状量表各症状及过度概括化自传体记忆总分上存在显著性的统计学意义(P0.05);2相关分析表明,创伤后应激障碍患者PTSD症状的重复体验、回避功能、社会功能与过度概括化自传体记忆呈高度的正相关性,分别为(r=0.59,0.53,0.71,0.59;P0.05)。结论:创伤后应激障碍患者PTSD症状及过度概括化的自传体记忆明显,且过度概括化的自传体记忆水平越高,PTSD患者的重复体验、回避功能、社会功能问题就越明显。     

江西省万载县芳林小学爆炸案幸存小学生心理创伤后应激障碍调查

目的 了解爆炸案幸存者PTSD的患病率和临床特征.方法 根据DSM-Ⅳ有关PTDS的诊断标准,自编《一般情况调查表》等,于2003年5月12日调查爆炸幸存者100人.结果 受伤害重的学生比未受伤害的学生发生PTSD的比率高,总的发生率是17.2%.结论 重大灾难事件的心理危机干预,应涉及所有的相关人群.对PTDS患者应加强心理健康教育,并尽量减少外界不良应激源干扰.     

创伤后应激障碍患者血清细胞因子水平初探

目的初步探讨创伤后应激障碍(PTSD)患者血清细胞因子IL-2、IL-4、IL-6、IL-8、IL-10及TNF-α含量及其意义。方法采用酶联免疫吸附法(ELISA)对50例PTSD患者血清IL-2、IL-4、IL-6、IL-8、IL-10及TNF-α进行检测,并与对照组进行比较。结果 PTSD组血清IL-2、IL-4、IL-6、IL-8、IL-10及TNF-α水平显著高于正常对照组(P<0.01)。结论 PTSD患者存在广泛的免疫异常。     

中文版创伤后应激障碍诊断量表在震后受灾人群中的适用性

目的研究中文版创伤后应激障碍诊断量表(PDS-C)在震后受灾人群中的适用性。方法选取震后受灾人群(有效n=125)进行PDS-C问卷测试,再进行项目分析、信度分析、区分效度分析以及验证性因素分析。结果各题与除该题外的问卷总分相关系数范围为0.267~0.689。问卷Cronbach's alpha为0.891,子量表Cronbach's alpha范围为0.722~0.811。验证性因素分析的拟合指数为:χ2/df=1.261,RMSEA=0.046,FMIn=1.139,F0=0.236,ECVI=1.8。问卷总分对生活领域不同受损程度可以进行区分(F=12.875,P0.01)。结论中文版PDS问卷具有良好的心理测量学属性。     

癌症病人创伤后应激障碍的特点(综述)

创伤后应激障碍（Posttraumatic stressdisorder，PTSD）是由异乎寻常的威胁性或灾难性心理创伤导致的延迟出现和长期持续的精神障碍，主要表现为反复出现闯入性的创伤性体验，持续的高警觉和回避。最初有关创伤后应激障碍的研究大部分集中在与战争、自然灾害和人为灾害有关的创伤事件中。     

创伤后应激障碍患者的血清细胞因子相关性

目的:探讨海南地区创伤后应激障碍(PTSD)与血清细胞因子的相关性。方法:选择海南地区创伤后应激障碍患者和健康对照者各57例,应用酶联免疫吸附法(ELISA)检测血清中IL-2、IL-4、IL-6、IL-8含量。结果:创伤后应激障碍组血清中IL-2(t=16.017,P=0.000)、IL-6(t=21.292,P=0.000)、IL-8(t=7.006,P=0.000)含量显著高于对照组。两组人群血清中IL-4含量差异无统计学意义。结论:创伤后应激障碍与血清细胞因子含量的变化息息相关,IL-2、IL-6、IL-8可能在PTSD的发病机理中起着重要作用。     

PTSD大鼠杏仁核神经元和突触的超微结构研究

目的研究创伤后应激障碍(PTSD)大鼠杏仁核神经元及突触的超微结构改变。方法采用大鼠PTSD-无连续单一应激(SPS)模型,于SPS刺激后1d、7d、14d取大脑杏仁核组织,制备成超薄切片,进行透射电镜观察。结果模型组杏仁核可见凋亡神经元,尤以SPS-7d为明显,神经元胞质内线粒体外膜局部破损、嵴减少或空泡化,粗面内质网和高尔基复合体呈不同程度扩张,突触结构也有异常。结论PTSD时杏仁核神经元发生凋亡和突触变性改变。     

中国消防救援人员中创伤后应激障碍的症状结构

目的：分析我国消防救援人员中创伤后应激障碍的症状结构。方法：被试为685名经历过职业创伤暴露的消防救援人员,年龄27.5±6.0岁。采用创伤后应激障碍诊断量表的症状分量表进行评估。使用验证性因素分析对4个竞争性模型进行检验。结果：验证性因素分析与模型比较的结果支持七维混合模型优于其它竞争模型。结论：本研究结果支持采用闯入、回避、负性情感、快感缺失、外化行为、焦虑性唤起和痛苦性唤起等7个症状簇能更好地解释与组织创伤后应激障碍的症状结构。     

MMPI-PK量表评估应激障碍的效果

目的：探讨应激障碍（SD）患者的病理心理特征及MMPI-PK量表的评估效果。方法：实验组为43名入院治疗的SD患者，以44名适应良好的创伤幸存者为对照，均完成MMPI-2测试。结果：SD患者的PK分数显著高于对照组；不同性别，创伤经历和诊断分类的SD患者的PK分数无显著差异；最佳截断点为原始分17分，PK量表评估SD的灵敏度为94．9％，特异度为66．7％。结论：SD患者和创伤幸存者的病理心理表现明显不同，PK量表可较好的评估创伤后的应激失常症状，但假阳性率较高。     

Electrophysiological responses to threat in youth with and without Posttraumatic Stress Disorder

The current study was designed to examine event-related brain potentials and autonomic responses to pictures indicating threat, relative to non-threat, and acoustic startle reflexes in traumatized youth diagnosed with PTSD, relative to non-exposed children, before and after receiving psychotherapy. Children in the control group were individually yoked and demographically matched to the PTSD group. Both groups displayed enhanced late positive potentials and more prolonged heart rate deceleration to pictures indicating threat, relative to non-threat, and larger skin conductance responses to pictures indicating threat, relative to non-threat, at time one. At time two, controls appeared to habituate, as reflected by an overall attenuated skin conductance response, whereas the PTSD group showed little change. Across time points the PTSD group exhibited greater acoustic startle reflexes than the control group. Psychotherapy and symptom reduction was not associated with electrophysiology. Drawing from the adult literature, this study was an attempt to address the scarcity of research examining electrophysiological irregularities in childhood PTSD. The overall results suggest that children and adolescents allocate more attention to threat-related stimuli regardless of PTSD status, and exaggerated startle and a possible failure to habituate skin conductance responses to threat-related stimuli in youth with versus without PTSD.     

Posttraumatic Stress Disorder: A Social‐Cognitive Perspective

This study offers a developmentally sensitive conceptual understanding of trauma by viewing posttraumatic stress disorder (PTSD) through the lens of social cognition. First, we justify our focus on social cognition by examining the literature on problematic interpersonal relationships associated with PTSD. Next, we link impaired social cognition to the developmental compromise of mentalizing capacity in attachment relationships. We then integrate the diverse research literature into a social‐cognitive model of the development of PTSD. We finally conclude by suggesting directions for future research, as it might be shaped by trends in social‐cognitive neuroscience.     

Posttraumatic Stress Disorder and Co‐Occurring Substance Use Disorders: Advances in Assessment and Treatment

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are prevalent and frequently co‐occur. Comorbid PTSD/SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including increased chronic physical health problems, poorer social functioning, higher rates of suicide attempts, more legal problems, increased risk of violence, worse treatment adherence, and less improvement during treatment. In response, psychosocial treatment options have increased substantially over the past decade and integrated approaches—treatments that address symptoms of both PTSD and SUD concurrently—are fast becoming the preferred model for treatment. This article reviews the prevalence, etiology, and assessment practices as well as advances in the behavioral and pharmacologic treatment of comorbid PTSD and SUDs.     

A meta-analysis of the relationship between symptom severity of Posttraumatic Stress Disorder and executive function

Introduction: Some studies of Posttraumatic Stress Disorder (PTSD) find executive dysfunction, whereas others do not. We meta-analytically examined the association between executive function and PTSD and used meta-regression to examine the potential moderating effect of PTSD severity on executive function.

Methods: We conducted a meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified published peer-reviewed articles containing measures of executive function and PTSD symptom severity in subjects with PTSD compared to trauma-unexposed controls or trauma-exposed controls without PTSD, or both. We calculated an effect size for each study containing at least one measure of executive function and PTSD symptom severity.

Results: PTSD subjects for whom the Clinician-Administered PTSD Scale (CAPS) score was available had worse executive function compared to both trauma-unexposed controls (g?=?0.464, p?<?.001) and to trauma-exposed controls without PTSD (g?=?0.414, p?=?.001), as did PTSD subjects for whom the Mississippi Scale for Combat-Related PTSD (M-PTSD) score was available (g?=?0.390, p?<?.001). Neither CAPS nor M-PTSD scores significantly moderated the effect size of executive function.

Conclusions: PTSD is associated with executive dysfunction, but this association was not moderated by PTSD symptom severity, suggesting that once PTSD occurs, executive dysfunction may occur regardless of PTSD severity.     

Efficacy of Posttraumatic Stress Disorder Treatment for Comorbid Panic Disorder: A Critical Review and Future Directions for Treatment Research

A systematic review of trauma treatment outcome literature was conducted to determine the impact of treatment on comorbid panic symptoms. Major databases were searched (from 1989 to 2013) and 64 randomized controlled trials using cognitive behavioral approaches to treat acute stress disorder, subthreshold posttraumatic stress disorder (PTSD), and full PTSD met inclusion criteria for this review. Results showed that 41% of the studies reviewed did not assess for Axis I psychiatric comorbidity at any point during the course of treatment. Only 5% of the studies reviewed reported rates of comorbid panic disorder (PD) at more than one time point during the study. Results indicate that approximately 56% of people no longer meet PD criteria following PTSD treatment.