术后镇痛对创伤患者围术期细胞因子和胰岛素抵抗的影响研究

研究术后镇痛对创伤患者围术期细胞因子IL 6、TNFα和胰岛素抵抗(IR)的影响.选取60例患者,随机分为两组,A组患者应用一次性术后镇痛泵,加入舒芬太尼2.5μg/kg+盐酸托烷司琼4mg,用生理盐水稀释至100ml,2ml/h持续注入.B组患者为术后根据临床需要临时给予杜冷丁每次50mg～100mg肌肉注射,每日不超过3次.发现两组患者术后镇痛效果比较,A组患者舒适程度要优于B组,随访患者无与药物相关的不良反应.术后两组患者血浆IL-6、TNF-α水平均开始升高,术后12h左右达峰值,24h后开始回落,但均明显高于术前.血糖和血胰岛素值也在术后升高,术后24h左右达峰值,之后逐渐回落.ISI在术后开始降低,术后24h降到最低,之后逐渐回升,但均低于术前,说明IL-6、TNF-α水平升高与创伤后胰岛素抵抗有相关性.A组患者术后12h、24h、36h、48h的血糖、血胰岛素、IL-6、TNF-α水平与B组比较明显降低,而且术后48h基本可以恢复术前水平.应用舒芬太尼术后镇痛可以通过抑制血浆中IL-6和TNF-α水平,从而抑制围术期胰岛素抵抗,降低应激反应,从而达到减轻免疫抑制和降低或缩短IR时间的目的.     

Psychological Consequences of Pregnancy Loss and Infant Death in a Sample of Bereaved Parents

This study aimed to explore a broad range of psychological reactions to trauma in a sample of bereaved parents in order to assess whether the traumatic framework is adequate for describing the entire range of emotional reactions to infant death. A sample of bereaved parents (N = 455) who lost their child through perinatal or postnatal loss were compared to a control group of parents (N = 110) who gave birth to a healthy child. Multivariate regression analysis clearly demonstrated that bereaved parents scored significantly higher on the Depression, Anxiety, Dissociation, Sleep Disturbances, Somatization, Interpersonal Sensitivity, and Aggression subscales of the Trauma Symptom Checklist. Consistent with previous studies, the results showed that for up to 5 years postloss bereaved parents expressed elevated levels of trauma-specific and psychological outcomes, in particular interpersonal sensitivity and aggression.     

Thoughts on representation in therapy of Holocaust survivors1

This paper presents the problems of representation and lack of representation in treating Holocaust survivors, through clinical vignettes and various theoreticians. The years of Nazi persecution and murder brought about a destruction of symbolization and turning inner and external reality into the Thing itself, the concrete, or, in Lacan’s words, ‘The Thing’. The paper presents two ideas related to praxis as well as theory in treating Holocaust survivors: the first is related to the therapist’s treatment of the Holocaust nightmare expressing the traumatic events just as they happened 63 years previously; the second deals with the attempt at subjectification, in contrast to the objectification forced by the Nazis on their victims.     

Top Ten Questions Male Sexual Abuse Survivors Want to Know from Health Care Research

Sexual abuse is an often overlooked public health issue for boys and men. Given its prevalence and well-documented connection to mental and physical health disorders, the relevance of male survivor input and engagement in health care research is profound. Using a community-based participatory research design, an in-person focus group with male survivors of sexual abuse and researchers was conducted. This paper describes the top ten research questions male sexual abuse survivors would like to have answered. Survivors were most interested in knowing how sexual abuse and assault impact men’s emotional and sexual functioning, what factors are involved in preventing and treating sexual assault-related emotional distress, and what can be done to prevent sexual abuse of boys and men. The fact that some of the questions survivors expressed an interest in knowing about have actually previously been investigated by researchers suggests a disconnect in translating evidence-based findings. Clinical and research implications include designing outreach interventions and gender-specific psychoeducation to increase engagement and access to care for men.     

A National Survey of Trauma Training in Psychology Internships

Directors from psychology internship programs across the United States were asked to participate in a survey regarding their sites’ provision of services to traumatized populations and didactic and supervisory training offered to interns. All totaled, 259 training directors completed the survey. Using a point system, an impact score of training saturation was determined based on the content and frequency of training offered in didactic, supervision, or combined formats. Of these, all reported at least one trauma training opportunity in either didactic or supervision format. More than half indicated that they offered at least 1 to 3 hours of didactics on trauma per week (62.2%) and slightly less offered supervision-specific training opportunities (54.5%). However, only 30.8% identified training opportunities in trauma/posttraumatic stress disorder that reached a high level of saturation in training, meaning they offered training activities above the median impact score. The most commonly reported barrier to offering trauma training was related to being busy meeting other specialty or program requirements. Findings provide a preliminary overview of current training practices that can be useful to students seeking trauma internship placements and administrators and faculty who are looking to revise their curriculum.     

Aggression in Children With Reactive Attachment Disorder: A Sign of Deficits in Emotional Regulatory Processes?

Children diagnosed with reactive attachment disorder (RAD) have been reported to exhibit a multitude of symptoms and behaviors that are not captured by the Diagnostic and Statistical Manual of Mental Disorders criteria. One behavior in particular that has been the source of much argument and controversy is aggression. Although limited research on this topic does support an association between aggression and RAD behaviors, the exact nature of this link remains unclear. This study aims to fill this gap by reporting data from a study that examined the behavioral processes that occur in adopted children with RAD. Guided by the principles of grounded theory, this study employed a multi-stage semi-structured interview design. The sample consisted of 5 adoptive families, and included both adult and child participants, including the adopted children with RAD. The findings revealed 5 prominent themes: The adopted children are reported to engage in extreme and prolonged tantrums, known as rages; children were often inconsolable during these rages; these rages are perceived as uncontrollable by children with RAD; these rages are directed toward a discriminate caregiver; and the impetus for these rages appears to be associated with difficulties in adapting to environmental demands. An in-depth discussion that draws a theoretical connection between these rages and possible deficits in brain-based processes responsible for emotional regulation is presented.     

Validation and Standardization of the Dutch Trauma Symptom Checklist for Young Children in a Normative and Clinical Sample

The study aimed to describe the psychometric properties of the Dutch version of the Trauma Symptom Checklist for Young Children (TSCYC) in normative and clinical populations in the Netherlands. Caregivers’ ratings on the TSCYC were obtained for 1,802 children from the normal population, and for 515 children from a clinical population of traumatized children. In the clinical sample, additional measures were taken. The internal consistency and test-retest reliability of TSCYC scales were adequate. Confirmatory factor analysis showed acceptable fit on the putative scale structure. Regarding criterion validity, the clinical sample scored significantly higher on all clinical scales when compared to the normal population sample. Within the clinical sample, significant associations were found between TSCYC scales and convergent scales of other instruments. The Posttraumatic Stress-Total subscale demonstrated excellent discriminative ability between traumatized children and children from the normal population. The Dutch version of the TSCYC proved a valid and reliable instrument to measure trauma symptoms in young children through caregiver report, similar to the original American version. Further comparisons with diagnostic interviews are warranted.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

Being undone by research: an ethical obligation to togethering

I interviewed 24 women who participated in self-defense and handgun training classes who revealed lives that had been intentionally hidden, sharing the unspeakable experiences of incest, rape, child abuse, and domestic violence through stories of survival and resistance. In a poem to my participants, I reflect on my role as researcher and my desire to fulfill a commitment to my participants.

Hearing women’s stories of sexual and other violent assault, I not only experienced secondary trauma, but I have been charged with a mission of developing research products that will change policy. I wrote this poem as a way to communicate the complicated ethical issues that arise when conducting research with participants who reveal traumatic stories.     

Cross-Cultural Challenges to the Construct “Posttraumatic Growth”

Responses of individuals to traumatic events are varied. Traumatic events can lead to positive transformations that are known as posttraumatic growth (PTG). Most of the empirical studies of PTG have been addressed from a Western perspective. Theoretically, the concept appears to be cross-culturally valid, but there has been a fundamental deficiency in operationalizing the concept in regard to cultures that are non-Western. Cultural elements play an important role in influencing the behavior of individuals in the aftermath of trauma. Hence, it is important to conceptualize and measure PTG in the framework of the culture to which the individual belongs. The effects of culture come from both the immediate culture (proximal) and the broader (distal) sources that impact the nature of rumination, cognitive strategies, and the process of growth. This paper addresses various cross-cultural challenges to the construct PTG such as emic versus etic perspectives on PTG, proximate and distal influences of culture on PTG, specific cultural influences on rumination, cognitive strategies, and growth, cultural bias inherent in theories of PTG, and measurement issues of PTG across cultures.