影响应激障碍治疗方案确立的临床特征

急性应激障碍和创伤后应激障碍是近些年创伤后研究的重要内容.为了更加全面地评估遭遇创伤事件患者的情况,本文将从年龄、性别、种族和文化因素、生理与心理共病、过去受伤史、攻击行为、自伤和自杀行为7个方面阐述影响应激障碍的因素,以期在影响应激治疗因素层面为临床治疗提供依据.     

阻碍条件性恐惧记忆消退的原因分析

创伤后应激障碍是个体经历严重应激后形成的一种焦虑障碍,对其治疗的关键是消退由创伤应激导致的条件性恐惧记忆,但目前最有效的暴露疗法并不能真正有效地抑制患者恐惧记忆的表达.对条件性恐惧的动物模型研究发现情绪性增强效应、恐惧记忆二级条件化与再巩固、内侧前额叶皮层功能不足等均能够阻碍条件性恐惧记忆的消退.针对这几个方面可以探索治疗创伤后应激障碍的相应方法.     

中小学生的灾难暴露程度对创伤后应激障碍的影响：中介和调节效应

汶川地震后1年时,采用灾难暴露程度问卷、主观害怕程度问卷、社会支持问卷和创伤后应激障碍症状量表,对地震极重灾区的3058名中小学生进行调查,考察灾难暴露程度、主观害怕程度、社会支持与创伤后应激障碍的关系。结果发现：（1）震后1年时中小学生创伤后应激障碍的发生率为9.6%,其中有目睹他人死亡经历的学生的创伤后应激障碍发生率为16.2%;（2）灾难暴露程度能正向预测创伤后应激障碍,而主观害怕程度在灾难暴露程度对创伤后应激障碍的影响中起部分中介作用;（3）社会支持在灾难暴露程度与创伤后应激障碍的关系中起调节作用,但不能调节主观害怕程度与创伤后应激障碍之间的关系。其中,无论支持的性质如何,父母和教师的支持都能缓解灾难暴露程度对创伤后应激障碍的影响,而同学和其他人的支持则不具有调节效应。     

军事应激障碍的评估与防治

军事应激障碍是部队常见的心理障碍,也是严重影响部队战斗力的主要因素。探讨军事应激障碍的评估方法和防治措施是军事心理学研究的重要内容。本文系统地回顾了国内外军事应激障碍的评估原则和方法,并结合过去的研究成果,提出了军事应激障碍的防治措施。目的是为我军制定切实可行的军事应激防治措施提供科学依据,以维护部队官兵的心理健康,提高部队的战斗力     

创伤后应激障碍与物质使用障碍共病的病因学及其启示

创伤后应激障碍与物质使用障碍共病率高,现有的治疗方法疗效差,总结20年来创伤后应激障碍与物质使用障碍共病研究中病因学方面的新认识,通过对病因的哲学思考可以为今后的治疗方向提供一条思路:两病同治;应提倡药物治疗、认知干预和社会支持综合的治疗手段.     

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     

创伤后应激障碍的认知理论

创伤后应激障碍是少数具有相对明确病源的精神障碍之一,而且具有独特的临床特 征,如创伤事件的频繁闪现、过度警觉等。关于创伤后应激障碍,存在多种理论解释,该文 对创伤后应激障碍的认知理论作一简要介绍和评述。     

主动反刍、创伤后应激障碍与创伤后成长的关系:一项来自汶川地震后青少年的长程追踪研究

本文以追踪研究的方式, 在汶川地震后3.5年、4.5年和5.5年三个时间点, 采用反刍问卷、创伤后应激障碍问卷和创伤后成长问卷对汶川地震后245名中学生进行调查。通过建立交叉滞后模型, 考察主动反刍、创伤后应激障碍与创伤后成长的相互作用关系。结果发现, 震后3.5~5.5年间, 创伤后应激障碍对主动反刍具有跨时间点的正向预测作用, 主动反刍对创伤后应激障碍跨时间点的预测作用不显著;主动反刍与创伤后成长之间存在跨时间点的相互正向预测关系;创伤后应激障碍与创伤后成长之间跨时间点的直接预测作用不显著, 但震后3.5年的创伤后应激障碍可以通过震后4.5年的主动反刍间接地正向预测震后5.5年的创伤后成长;创伤后应激障碍与创伤后成长的横断关系随着时间历程的变化而逐渐减弱。     

青少年的创伤暴露程度与创伤后应激障碍的关系——核心信念挑战、主观害怕程度和侵入性反刍的作用

采用创伤暴露程度问卷、核心信念量表、主观害怕程度问卷、反刍问卷和创伤后应激障碍问卷,以雅安地震6个月后的310名中学生为被试,考察其创伤暴露程度、核心信念挑战、主观害怕程度、侵入性反刍与创伤后应激障碍之间的关系。结果发现,雅安地震6个月后青少年的创伤后应激障碍的发生率及整体水平较低,其中男生水平低于女生,高一年级学生水平相对高于初一、初二和高二年学生。结构方程模型的结果显示,创伤暴露程度可以通过核心信念挑战对创伤后应激障碍起正向预测作用,也可以通过核心信念挑战经侵入性反刍的多重中介来正向预测创伤后应激障碍;创伤暴露程度还可以通过主观害怕程度经侵入性反刍的多重中介来正向预测创伤后应激障碍。但是创伤暴露程度不能直接通过侵入性反刍预测创伤后应激障碍,也不能通过主观害怕程度直接预测创伤后应激障碍。     

创伤后应激障碍的认知理论

创伤后应激障碍是少数具有相对明确病源的精神障碍之一,而且具有独特的临床特征,如创伤事件的频繁闪现、过度警觉等。关于创伤后应激障碍,存在多种理论解释,该对创伤后应激障碍的认知理论作一简要介绍和评述。     

Analysis of long-term stress reactions in emergency room patients: An initial study

The psychological stress reactions of 44 family medicine patients who were treated in the emergency room were examined approximately a year after the event. Patients were assessed on several psychological measures, including one for posttraumatic stress disorder (PTSD), and on their perception of how stressful the event was initially and now. Results show continuing stress reactions related to the emergency room event. Three patients endorsed symptoms indicating full PTSD and 13 appeared to have at least partial PTSD. Age appeared to be a factor in the presence of stress symptoms and in degree of perceived communication with the physician.     

The Development and Experience of Combat‐Related PTSD: A Demand for Neurofeedback as an Effective Form of Treatment

Veterans experience a considerable course of posttraumatic stress disorder (PTSD), and because of several psychosocial issues, traditional interventions and traditional intervention settings are ineffective for this population. A new cutting‐edge approach, known as neurofeedback, trains clients to control and manipulate their central nervous system and ameliorate physiological symptoms of stress disorders. The authors delineate how neurofeedback can be an effective and innovative intervention for PTSD experienced by the military population.     

Involvement and role of the hypothalamo-pituitary-adrenal (HPA) stress axis in animal models of chronic pain and inflammation

Hypothalamo-pituitary-adrenal (HPA) axis changes have been reported in several disease states, including major depressive disorder, rheumatoid arthritis, multiple sclerosis and various other conditions associated with chronic pain. These observations suggest that stress and the HPA axis may play important roles in the pathology of these diseases. In order to contribute to a better understanding of the role that chronic stress may play in human pathology, this review article explores the involvement of the HPA axis in those animal models of chronic pain and inflammation that entail persistent rather than intermittent stress.     

Posttraumatic stress disorder in a patient with no left amygdala

Existing biological models of posttraumatic stress disorder (PTSD) posit that the amygdala plays a critical role in the development and expression of this disorder. However, increasing data indicate that the amygdalae are not functionally identical, raising the possibility that the 2 amygdalae may make differential contributions to the expression of PTSD. The authors present a unique patient who developed PTSD following a traffic accident that occurred 2 years after she had undergone removal of her left amygdala to treat pharmacologically intractable epilepsy. The authors propose that the right amygdala is preferentially involved in several processes related to the expression of PTSD symptoms, such that the disorder can occur even in the absence of the left amygdala.     

Risk Factors for Isolated Sleep Paralysis in an African American Sample: A Preliminary Study

Isolated sleep paralysis (ISP) is a temporary period of involuntary immobility that can occur at sleep onset or offset. It has previously been reported in association with both panic disorder (PD) and posttraumatic stress disorder (PTSD). The current study examined the association between ISP and several possible risk factors—anxiety sensitivity, trauma exposure, life stress, and paranormal beliefs—in a sample of African American participants with and without a history of ISP. Significant between-group differences were found for PD and PTSD diagnoses, anxiety sensitivity, life stress, and certain aspects of paranormal belief, with the ISP group being higher on all of these indices. No differences were found with regard to trauma exposure. Hierarchical regression analyses indicated that PD, anxiety sensitivity, and life stress each contributed unique variance to ISP cognitive symptoms, whereas PTSD and paranormal beliefs did not. These results provide preliminary support for an association between ISP and anxiety sensitivity and corroborate previous reports of ISP's association with PD and life stress. The current trauma/PTSD findings are mixed, however, and warrant future research.     

Anxiety disorders in African-American and white children

There are little available data on African-American children with anxiety disorders. Treatment-seeking African-American (n=30) and white children (n=139), with a current DSM-III-R anxiety disorder, were compared on sociodemographic background variables, clinical characteristics, and lifetime rates of specific DSM-III-R anxiety disorders. Overall, results suggested that the anxiety-disordered African-American and white children who sought treatment from an outpatient mental health facility were more similar than different. The two groups did, however, differ somewhat on several variables (trend only), including rates of school refusal, severity of primary anxiety disorder, lifetime prevalence of posttraumatic stress disorder, and total scores on the Fear Survey Schedule for Children-Revised. More specifically, white children were more likely to present with school refusal and higher severity ratings, while African American children were more likely to have a history of posttraumatic stress disorder and score higher on the FSSC-R. The impact of these findings and the need for additional research are discussed.This study was supported in part by MH grant 40021 from the National Institute of Mental Health.     

Sexually abused children suffering from post-traumatic stress disorder: assessment and treatment strategies

Child sexual abuse is a highly prevalent problem that frequently occasions the onset of post-traumatic stress disorder in the victimized youngster. This selective review addresses recent advances in the assessment and treatment of sexually abused children with post-traumatic stress disorder. Firstly, we outline the diagnostic criteria for post-traumatic stress disorder and significant moderating variables in the development of post-traumatic stress disorder. Secondly, we address the clinical assessment of post-traumatic stress disorder in sexually abused children, recommending a developmentally sensitive, multi-informant approach. Thirdly, we consider a family-wide cognitive-behavioural treatment framework for sexually abused children with post-traumatic stress disorder that involves both child and non-offending caregivers. Fourthly, we examine the results of recent evaluation studies supportive of cognitive-behavioural therapy in the treatment of sexually abused children. Lastly, we consider conclusions for clinical practice and directions for future research.     

The Monsters in My Head: Posttraumatic Stress Disorder and the Child Survivor of Sexual Abuse

Posttraumatic stress disorder (PTSD) is 1 of several possible outcomes of child sexual victimization. There is a growing body of literature regarding the prevalence of PTSD among children who have been sexually victimized. Using specific case examples, this article looks at the nature and scope of the problem, diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) symptomatology of children presenting with this disorder, assessment and diagnosis, treatment interventions, and implications for counselors treating this population.     

Interoceptive exposure therapy combined with trauma-related exposure therapy for post-traumatic stress disorder: a case report

Trauma-related exposure therapy is a useful but not universally effective treatment for post-traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post-traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma-related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale, a self-report measure of post-traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post-traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1- and 3-month follow-up. Symptoms of anxiety sensitivity and post-traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post-traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma-related exposure therapy as a means of boosting treatment efficacy.     

急性应激障碍（ASD）研究述评

急性应激障碍是个体在亲历、目击或面临一个对自己或他人具有死亡威胁、严重伤害的创伤事件后的2天至4周内所表现的应激反应。急性应激障碍的症状主要表现为分离、再历、回避和过度警觉。文章回顾了以往的相关研究,从急性应激障碍的测评方法、发生率、与创伤后应激障碍和创伤记忆的关系、心理治疗和干预等方面进行了综述。最后对未来可能的研究方向提出了展望