An Analogue Study of the Psychological and Psychosocial Processes Associated With Post‐concussion Symptoms

This study used an analogue design to investigate post‐concussion syndrome and the psychological and psychosocial processes associated with post‐concussion symptom (PCSx) reporting. The study examined the role of expectation in reporting of PCSx, the nature of associated psychological and psychosocial difficulties, and the “good‐old‐days” phenomenon. Forty‐five healthy participants were randomly assigned to one of two groups: (1) a control group or (2) an expectation group who were asked to perform as if they had experienced a mild traumatic brain injury. Fourteen psychiatric patients comprised the clinical group. Self‐report questionnaires assessing PCSx and psychological and psychosocial variables were administered. It was hypothesised that PCSx would be non‐specific, that the expectation group would report greater dysfunction than controls, and that the “good‐old‐days” phenomenon would cause the expectation and clinical groups to underestimate pre‐morbid PCSx. All participants reported some degree of dysfunction, and the expectation and clinical groups underestimated past PCSx. The expectation group reported more PCSx and psychological and psychosocial dysfunction than controls, resembling the clinical group. The results demonstrate that expectation can cause otherwise healthy individuals to resemble a clinical group in terms of their level of endorsement of psychological and psychosocial dysfunction.     

神经症躯体症状的特点与诊断原则

作为临床医生,难免与一些难以解释的躯体症状打交道,这其中有些最终可以确定是精神障碍的躯体症状。从躯体症状识别精神障碍,没有捷径可走,除了良好的医学基础,更要了解精神障碍的特点。这样即便是躯体疾病同样存在的情况下,也能发现精神障碍。套用政治术语,叫做"两手抓,两手都要硬"。即便如此,还有一些医学难以解释的症状,其发生基础无论从生物学医学还是精神病学角度都还不清楚,而这正是需要我们着力研究的学科交叉点。     

Stress and depression of facing death: Investigation of psychological symptoms in patients with mesothelioma

Cancer often results in psychological impairment, and lung cancer has been associated with greater morbidity and higher levels of psychological distress than any other form. Chronic exposure to asbestos is a significant risk factor for development of lung cancer, called mesothelioma. Few have studied the psychological consequences of chronic asbestos exposure and mesothelioma. This study investigated stress and depression symptoms in 49 men (M = 51.1 years, SD = 6.0) diagnosed with mesothelioma. Participants completed traumatic stress, depression and general psychological health questionnaires. All participants reported significant levels of traumatic stress symptoms, which was associated with increased symptoms of depression, anxiety, somatic complaints and social dysfunction. The results provide important suggestions for clinicians treating such terminally ill patients.     

综合医院抑郁症和神经症诊疗决策的思考

抑郁症和神经症是一种慢性易复发性精神疾病,发病率高,疾病负担重,多数患者都就诊于综合医院非精神专科,而目前的现状是综合医院的各科医生对此类疾病的识别率低、治疗率低,患者依从性差。结合临床提出了关于综合医院如何提高抑郁症和神经症的识别率,医生在精神疾病诊疗中应注意的问题以及如何提高患者治疗依从性等临床亟待解决的问题。     

产褥期抑郁症的高危因素及防治措施的分析

产褥期抑郁症是指产妇在产褥期内出现抑郁症状,是产褥期精神综合征中最常见的一种类型.国外报道发生率达30%,国内资料较少,防治措施亦少.通常在产后6周内发病,产后2周出现症状,表现为易激惹、恐怖、焦虑、沮丧等,有时还会陷入错乱或嗜睡状态.既往无精神病史,包括抑郁症在内的抑郁症史.现对我院2004年6月～2005年6月分娩产妇中随机抽取有随访条件的1824例产妇进行调查,有产后抑郁症状者达289例,发生率15.84%.     

Gender Group Differences in Coping with Chronic Terror: The Israeli Scene

Gender group differences in terror–stress, cognitive appraisals, ways of coping with terror, and stress reactions were explored in a sample of Israeli adults following prolonged exposure to political violence. Data were gathered at the height of the Al-Aqsa Intifada uprising (May/July 2002) from a sample of 707 adult participants (60% women and 40% men) residing in Haifa and northern Israel. Israeli women reported that they were more distressed by political violence than the men did, and they also appraised the crisis situation as more threatening and less manageable. Women reported using more problem-focused as well as emotion-focused coping than men did; both men and women used a mixture of coping strategies. Compared to men, women reported that they experienced more somatic symptoms and more frequent posttraumatic stress symptoms than men did. Negative affectivity was found to mediate gender differences in appraisals, coping, and outcomes. Overall, the nexus of relations among key variables was found to be highly similar for men and women. These data suggest that women may be more reactive to chronic political violence situations than men are. The data are discussed and explicated in the context of stress and coping theory and prior research on political violence and community disasters.     

An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury

Post-9/11 service members may return from military service with a complicated set of symptoms and conditions, such as posttraumatic stress disorder (PTSD), depression, substance misuse, and traumatic brain injury (TBI), that interfere with reintegration and impair functioning. Although evidence-based treatments that facilitate recovery exist, their successful delivery at a sufficient dose is limited. Barriers to accessing treatment combined with challenges compiling a comprehensive treatment team further delay delivery of effective evidence-based care for PTSD, TBI, and co-occurring mental health conditions. This paper describes the development of a comprehensive, multidisciplinary, 2-week intensive day program for post-9/11 veterans with complex mental health concerns. The treatment program combines skill building groups, family education, and integrative health approaches with evidence-based individual PTSD or TBI care. Initial results from the first 132 participants were notable for a 97% completion rate, as well as statistically significant and clinically meaningful reductions in PTSD, neurobehavioral, and depression symptom severity for the 107 veterans who completed the PTSD track and the 21 who completed the TBI track. These data suggest the intensive program approach is an effective, well-tolerated model of treatment for post-9/11 veterans with PTSD and/or TBI. Future controlled studies should examine the effectiveness of this intensive model compared to standard evidence-based therapy delivery, as well as longitudinal outcomes.     

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety,Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.     

When Treatment is Traumatic: An Empirical Review of Interventions for Pediatric Medical Traumatic Stress

Pediatric medical traumatic stress (PMTS) is common among injured/ill children and is associated with elevated distress, treatment non‐adherence, and poor health outcomes. As survivorship of life‐threatening pediatric injury and illness continues to increase alongside rapid medical advancements, rates of PMTS and negative sequelae are expected to grow; however, research on prevention and treatment of PMTS is limited. The current study sought to systematically review the literature using a developmental framework to highlight research gaps. Sixteen peer‐reviewed studies were identified via a systematic literature search. Consistent with best practices for treatment of childhood trauma, caregiver involvement and CBT principles served as the foundation for most interventions. All studies reported improvements in PMTS; however, among the most methodologically rigorous, few found statistically superior reductions in PMTS between intervention and control groups. While many studies focused on a specific developmental stage and discussed developmental considerations, others took a “one‐size‐fits” approach. Interventions that demonstrated the most promising findings were online, self‐guided, or time‐limited. Future research would benefit from expanding diversity of participants, continuing to evaluate novel delivery methods, and integrating developmental considerations along with trauma‐informed care (TIC) approaches, given their useful framework for understanding child traumatic stress responses and avenues for prevention and treatment.