创伤后应激障碍的动物模型及其神经生物学机制

创伤后应激障碍是指个体由于经历对生命具有威胁的事件或严重的创伤,导致症状长期持续的精神障碍。研究创伤后应激障碍的主要动物模型为条件性恐惧和应激敏感化模型。研究表明,创伤后应激障碍中长时程留存的恐惧性记忆、高唤醒等症状与大脑杏仁核、内侧前额叶皮层和海马三个脑区及下丘脑-垂体-肾上腺轴负反馈功能增强密切相关。其中杏仁核活动增强是条件性恐惧记忆获得、保持和表达的关键神经基础。内侧前额叶皮层对杏仁核的去抑制及海马向杏仁核传递的威胁性环境信息,促进创伤后应激障碍症状的出现。在经历创伤应激后糖皮质激素受体的上调及多巴胺活动的增强是创伤后应激障碍产生的主要神经基础。对创伤后应激障碍的药物治疗研究证明多巴胺D2受体在改善患者症状中的作用比较重要,但仍需作更深入的探索     

创伤后应激障碍患者情绪记忆优势研究述评

创伤后应激障碍(PTSD)是由高情绪刺激引起延迟出现和长期持续的精神障碍。闯入、闪回、病理性重复体验、持续性警觉性增高和回避等症状严重损害其认知功能。PTSD患者记忆形成了情绪网络。情绪记忆具有强烈、持久的特点, 在记忆中具有优势地位。回顾PTSD患者情绪记忆优势的行为及脑成像研究发现, PTSD患者情绪记忆优势研究结果并不完全一致, 受到诸多因素的影响, 这些影响因素需进一步探讨。     

Confirmatory Factor Analysis of the Posttraumatic Stress Disorder Checklist

Several studies have employed confirmatory factor analysis (CFA) to examine the latent structure of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993), a measure that assesses PTSD symptomatology. Findings have failed to support the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]; American Psychiatric Association, 2000) PTSD model, consisting of reexperiencing, avoidance/numbing, and arousal factors, and no consensus has emerged regarding the best fitting alternative model. Additionally, most studies have utilized homogeneous trauma samples. This study used CFA to examine the PCL factor structure in a sample with exposure to various traumatic events. Superior fit was demonstrated by a model specifying reexperiencing, avoidance, dysphoria, and arousal factors.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

Breast Cancer as Trauma: Posttraumatic Stress and Posttraumatic Growth

Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.     

创伤后应激障碍的民族差异问题

创伤后应激障碍(PTSD)的民族差异主要体现在少数民族PTSD的发生率较高和症状反应与症状结构的差异。以美国代表的西方国家的研究表明, 这些差异主要是源于暴露水平、少数民族的社会地位以及不同的文化背景。汶川地震后, 有研究也发现羌族PTSD发生率高于汉族, 然而对于羌汉民族间症状反应的具体差异及其原因, 还并不十分明确。因此, 有必要在中国进行PTSD民族差异系统深入的研究, 这既有助于灾后心理援助工作更加有针对性的开展, 也能够为从东方文化视角下理解PTSD提供理论依据。     

A Systematic Review of the Posttraumatic Stress Disorder Checklist (PCL)

In this systematic review, the authors analyzed 336 published articles and dissertations that used the Posttraumatic Stress Disorder Checklist (PCL) to determine the reliability and validity of scores on 3 different versions: PCL–Specific, PCL–Military, and PCL–Civilian. Results confirmed Weathers, Litz, Herman, Huska, and Keane's ( 1993 ) claim that the PCL has adequate psychometric properties and appears to support the construction of a new version, the PCL‐5, as a population‐nonspecific instrument.     

Posttraumatic Stress Disorder and Marital Adjustment: The Mediating Role of Forgiveness

The study assessed the effects of war captivity on posttraumatic stress symptoms and marital adjustment among Prisoners of War (POWs) from the Yom Kippur War. It was hypothesized that men's perception of level of forgiveness mediates the relation between posttraumatic symptoms and marital adjustment. The sample consisted of 157 Israeli veterans divided into 3 groups: 21 POWs with Posttraumatic Stress Disorder (PTSD), 58 former POWs without PTSD, and 70 control veterans. The findings indicated that former POWs with PTSD reported lower levels of marital satisfaction and forgiveness than veterans in the other 2 groups. In addition, men's perception of level of forgiveness mediated the relationship between their posttraumatic symptoms and their marital adjustment. The theoretical and clinical implications of these results are discussed.     

Posttraumatic stress disorder: A sensitization reaction

This article discusses past research bearing on the question of the etiology of Posttraumatic Stress Disorder (PTSD). It argues that PTSD can be adequately accounted for by a process of emotional sensitization and that this is a more parsimonious explanation than the two-factor learning theory of Mowrer, now postulated by several writers. In brief, the etiology and subsequent development of PTSD is viewed as the result of the sensitization of fear/anxiety which is linked to a variety of to be conditional stimuli by both backward and forward association: these become conditional stimuli (CSi) once paired with the instigating circumstances. It is furthermore assumed that PTSD will not occur in the absence of a genetic susceptibility that may vary from zero to absolute certainty. Thus far, our evidence is limited to a sensitivity to loud sounds, but it is highly probable that touch and other sensory systems are involved (not necessarily in parallel). The fact that abuse often leads to behavioral disorders, including sexually seductive behaviors in children sexually abused, requires a recognition that emotional reactions other than fear may be sensitized. Fear in combination with pleasure or pleasure alone coupled with a loss of self-esteem may explain these acting-out behaviors.     

Comorbidity of attention Deficit Hyperactivity Disorder and Post-Traumatic Stress Disorder

Attention Deficit Hyperactivity Disorder (ADHD) and Post-Traumatic Stress Disorder (PTSD) show a high degree of comorbidity in traumatized children. Two hypotheses may help explain this relationship: children with ADHD are at higher risk for trauma due to their impulsivity, dangerous behaviors, and parents who may have a genetic predisposition for impairment of their own impulse control; and hyperarousal induced by severe trauma and manifested by hypervigilance and poor concentration may impair attention to create an ADHD-like syndrome. Four illustrative cases are presented, and implications for treatment are discussed.     

Neuropsychological Functioning in Children with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been associated with deficits in the areas of verbal memory and learning, executive functioning, working memory, and attention in adults. Findings have been less consistent in the few studies examining neuropsychological functioning in childhood PTSD, which are often limited by comparing children with PTSD to children without trauma histories, making it unclear whether observed neuropsychological deficits are related to trauma exposure or to PTSD symptomatology. In an ethnically diverse sample of 62 children who witnessed intimate partner violence (n = 27 PTSD+ and 35 PTSD?), children with PTSD exhibited slower and less effective learning, heightened sensitivity to interference, and impaired effect of rehearsal on memory acquisition on the California Verbal Learning Test – Children's Version, a word list learning task. Both groups performed in the below average range on measures of executive functioning, attention, and intellectual ability.     

Reward Processing and Decision-Making in Posttraumatic Stress Disorder

Theory suggests that, in those with posttraumatic stress disorder (PTSD), positive emotion is likely dampened due to reexperiencing of trauma-related stimuli. Prior research has extended positive emotion experiencing to reward processing research but has not yet examined how trauma cues affect reward processing (i.e., the anticipation of and satisfaction with reward) and decision-making in individuals with PTSD. We compared 24 individuals diagnosed with PTSD to 29 trauma-exposed controls in passive and decision-making phases of a wheel-of-fortune task, following both neutral and trauma inductions. Three types of spinners were used in the task: spinners that were obviously advantageous spinners, obviously disadvantageous spinners, and ambiguously advantageous spinners with outcomes averaging to a net gain. We hypothesized that the PTSD group would report lower reward expectation and lower outcome satisfaction and make less advantageous decisions, differences that would be exacerbated following a trauma prime. The PTSD group reported lower reward expectation than controls for the ambiguous spinners only, suggesting that the reduced anticipation of reward associated with PTSD may be specific to ambiguous stimuli. Reward expectation was not affected by the type of prime. Outcome satisfaction was not affected by PTSD or type of prime. Although only marginally significant, the PTSD group played the ambiguous spinners less often than controls, and played the obviously disadvantageous spinners significantly less often than controls, suggesting that those with PTSD are more aversive to loss. Our findings suggest that PTSD-related deficits are more robust for reward expectation than outcome satisfaction, and support future research examining the role of reward-related decision-making in PTSD.     

Trauma-related and neutral false memories in war-induced Posttraumatic Stress Disorder

Recent models of cognition in Posttraumatic Stress Disorder (PTSD) predict that trauma-related, but not neutral, processing should be differentially affected in these patients, compared to trauma-exposed controls. This study compared a group of 50 patients with PTSD related to the war in Bosnia and a group of 50 controls without PTSD but exposed to trauma from the war, using the DRM method to induce false memories for war-related and neutral critical lures. While the groups were equally susceptible to neutral critical lures, the PTSD group mistakenly recalled more war-related lures. Both false and correct recall were related more to depression than to self-rated trauma. Implications for accounts of false memories in terms of source-monitoring are discussed.     

Virtual Reality Exposure for Veterans with Posttraumatic Stress Disorder

Abstract

Two open trials of Virtual Reality based exposure therapy (VRE) to desensitize Vietnam veterans with Posttraumatic Stress Disorder (PTSD) to some of their traumatic memories are described. A total of 21 patients were exposed to one of two virtual Vietnam computer-generated environments in which their individual traumatic experiences were simulated in response to their recounting these events. Although two patients experienced significant increases in symptoms during VRE, all patients' PTSD symptoms were below baseline by the 3-month post-treatment assessment. When the data from the two open trials was combined, clinically meaningful and statistically significant reductions in PTSD symptoms were found. These changes were long lasting as evidenced by the 6-month follow-up assessments. Two case examples are provided and future applications of this treatment are discussed.     

Daily Posttraumatic Stress Disorder Symptom Accommodation and Relationship Functioning in Military Couples

Romantic partners’ accommodation of trauma survivors’ posttraumatic stress disorder (PTSD) symptoms (e.g., taking on tasks, survivors avoid participating in social withdrawal) is associated with lower relationship satisfaction for both partners and survivors. Little is known about associations of partner accommodation with other aspects of relationship functioning, like intimacy. Sixty‐four male military veterans with at least subclinical PTSD and their partners participated in a 2‐week daily diary study. Veterans completed nightly measures of PTSD symptoms, while female partners completed nightly measures of accommodating behaviors performed that day. Both partners reported feelings of intimacy each night. Multilevel models revealed that accommodation was significantly, negatively associated with feelings of intimacy, with stronger effects for partners (t = ?8.70) than for veterans (t = ?5.40), and stronger effects when veterans had lower (t = ?7.43) rather than higher (t = ?5.20) levels of daily PTSD symptoms. Therapists should consider accommodating behaviors as a potential impediment to relationship intimacy, particularly when veterans have less severe symptoms of PTSD. Accommodating behaviors are an ideal treatment target in behavioral couple therapies.     

创伤后应激障碍的认知功能缺陷与执行控制 ——5·12震后创伤恢复的认知基础

创伤后应激障碍（Posttraumatic stress disorder,PTSD）患者通常伴随着明显的认知功能损伤。例如,存在注意保持缺陷,对与创伤相关的信息表现出更多的注意偏向和应激反应;并存在对创伤信息的记忆偏向,在陈述性记忆和自传体记忆中表现出一定的缺陷。近年的研究积累了更多类似的证据,表明PTSD的认知损伤可能与执行功能缺陷密切相关,但这一解释是否正确仍有待进一步的研究。本综述对5·12汶川大地震后长期的心理干预工作,尤其是认知功能损伤人群的筛选、恢复以及相关科学研究具有现实意义和理论启发作用     

创伤暴露程度、主观害怕程度对儿童创伤后应激障碍影响的追踪研究:社会支持的调节作用

为了考察创伤暴露程度、主观害怕程度、社会支持与创伤后应激障碍（PTSD）之间的纵向关系,本研究采用创伤暴露程度问卷、主观害怕程度问卷、社会支持问卷与儿童创伤后应激障碍症状量表对雅安地震半年后的303名小学生进行测查,并于震后一年半时进行再次测查。逐步回归分析的结果发现,创伤暴露程度对地震半年后的PTSD具有显著的正向预测作用,对震后一年半的PTSD没有显著的预测作用;无论是震后半年还是一年半,主观害怕都可以加剧PTSD、社会支持都可以缓解PTSD;社会支持在创伤暴露程度与PTSD之间不起显著的调节作用,但却可以显著地调节主观害怕程度对震后一年半的PTSD的影响,表现为主观害怕程度对震后一年半的PTSD的正向预测作用随着社会支持水平的增加而降低。     

Cognitive Processing Therapy for Childbirth-Related Posttraumatic Stress Disorder: A Case Report

Having a baby is a natural biological process and commonly considered a positive and exciting time in life. However, birth and the postpartum period also represent a vulnerable time for mental health and the development of posttraumatic stress disorder (PTSD) among women who are exposed to traumatic events during birth. Childbirth-related PTSD (CB-PTSD) is a relatively new and unique construct, associated with negative impacts to the mother, her infant, and family more broadly. Research investigating psychological interventions following traumatic births remains scant and no studies have evaluated cognitive processing therapy (CPT), a well-established and empirically supported psychological therapy, in the treatment of CB-PTSD. We conducted a case study using CPT for CB-PTSD, modifying the length of the traditional protocol to eight sessions, and tailoring the content to meet the unique needs of postpartum women. Following CPT for CB-PTSD, clinically significant and meaningful treatment outcomes were produced in both PTSD and depressive symptoms, with gains maintained at 1-month follow-up. Our modified version of CPT for CB-PTSD was also highly acceptable with the participant in our case study. These findings provide initial support for CPT as a strong psychotherapeutic intervention option for targeting CB-PTSD. Further research is necessary to examine this treatment and its acceptability with a larger sample.     

Motor vehicle accident trauma exposure: Personality profiles associated with posttraumatic diagnoses

Abstract

Personality profiles associated with diagnostically distinct posttraumatic responses were examined. Profiles were compared between three groups defined on the basis of posttraumatic diagnosis following motor vehicle accident (MVA) trauma exposure. The diagnostic groups were: Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD) without progression to PTSD, and subclinical responses. Participants were male and female community volunteers aged 18 to 77 (N = 83) who had all been exposed to an MVA meeting the DSM-IV diagnostic criteria for a traumatic event. The Personality Assessment Inventory (Morey, 1991) was used to assess psychological variables in the framework of posttraumatic diagnostic groups. The PTSD group scored significantly higher than the ASD and subclinical groups on scales assessing somatic complaints, anxiety, anxiety related disorders, depression, non-psychotic symptoms of schizophrenia, and negative relationships. The profile of the ASD group was characterized by self report of greater interpersonal warmth and a trend for greater egocentricity than the PTSD group. There were no significant differences in the personality profiles of the ASD and subclinical groups. The role of personality factors in posttraumatic adjustment is discussed in the context of previous literature.     

Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans

Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up.Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.