灾后消防救援人员创伤后应激障碍分析

目的：对地震后消防救援人员创伤后应激障碍（PTSD）的发生率及心理健康状况进行分析。方法：选用创伤后应激评定量表（PCL-C）和中文版事件影响量表（IES-R）,对灾后三个月内消防员310人进行评估。结果：灾后三个月内PTSD症状的总发生率为35.3%;地震救援组和基层消防组IES-R得分显著高于一般院校组,但地震救援组和基层消防组得分无显著差异,PCL-C得分结果与之类似;恐惧、创伤经历和救援失败等是PTSD症状的影响因素。结论：消防员是职业心理创伤的高危人群,地震后消防救援人员PTSD症状发生率较高,应给予及时心理干预。     

创伤后应激障碍机制的研究进展

创伤后应激障碍(Post-traumatic stress disorder;PTSD)是一种由严重强烈的伤害事件造成的精神障碍,随着近年来社会应激事件的增多和自然灾害的发生,创伤应激障碍的发病率逐渐增高。同时为了研究对应的治疗方法,人们对创伤应激障碍的机制进行了更深入的探索,也有了新的进展。本文着重从激素、神经营养因子、免疫系统等方面来总结创伤后应激障碍发生的生物学机制。激素方面,PTSD主要与交感肾上腺髓质系统(Sympatho-adrenomedullarysystem,SAS)和下丘脑-垂体-肾上腺轴(Hypothalamicpituitary-adrenal axis,HPA)的功能异常有关;神经营养因子方面,其产生与分泌的异常增加或减少可能是PTSD产生的重要机制;免疫系统方面,PTSD可能与免疫系统相关的蛋白质、细胞的数量和功能变化有关。整合神经生物学与分子生物学、表观遗传学、蛋白质组学及分子影像学的成果将对PTSD的研究产生推动作用。     

创伤后应激障碍闯入性记忆的生物学机制

创伤应激障碍主要以记忆紊乱为临床表现,其中闯入性记忆是其最显著特征.本文就闯入性记忆发生的生物学机制着重从前额叶、海马和杏仁核、神经环路来探讨创伤应激对脑认知功能的损害机制.     

丙泊酚对创伤后应激障碍治疗作用的研究进展

丙泊酚作为一种广泛用于临床的短效静脉麻醉药,其复杂的作用机制和多样的效应促使人们不断探索其更广泛的临床用途。丙泊酚通过抑制中枢神经系统产生镇静催眠的作用,其遗忘效应有望改善焦虑状态,逆转快感缺乏,缓解抑郁症状,并在治疗创伤后应激障碍方面发挥作用。本文介绍了丙泊酚的临床应用现状和创伤后应激障碍的发病机制,综述了丙泊酚在创伤后应激障碍中的影响及可能的作用机制,并探讨了丙泊酚作为一种新的治疗手段应用于创伤后应激障碍及其他神经精神疾病的可能性。     

创伤后应激障碍对慢性不可预见性应激抑郁模型的影响

目的:观察创伤后应激障碍(PTSD)对慢性不可预见性应激(CUS)抑郁模型的影响。方法:采用足底电击的方法建立大鼠创伤后应激障碍模型。成年雄性S-D大鼠40只随机分为四组(n=10):对照组(C组)、PTSD组、CUS组、PTSD+CUS组(P+C组)。在1、7、14、21天测量大鼠体重,并行糖水偏好和强迫游泳实验,在7、14、21天做条件性恐惧实验。结果:与C组相比,CUS组和P+C组体重增加缓慢,PTSD组体重正常。CUS组于第21天出现糖水消耗比例降低,强迫游泳不动时间增加。P+C组于第14天即出现上述抑郁表现。条件性恐惧实验中,PTSD组与PTSD+CUS组僵直时间显著增加,CUS组无明显变化。结论:创伤后应激障碍的动物更易产生抑郁表现。     

肝癌致创伤后应激障碍的心理咨询探讨

目的:初步探索心理咨询对肝癌所致创伤后应激障碍患者的干预效果。方法:一例肝癌患者接受六次心理咨询服务。采用PTSD症状评估和生活事件症状测评量表,在咨询第一次和第六次对患者实施测评,并收集患者及家属的主观描述。结果:患者经过认知行为、放松和眼动脱敏干预后,其警觉性下降、创伤再体验次数明显减少、睡眠状况改善以及对癌症治疗的管理观念提高,三个月后对患者及家属回访显示,患者症状改善在回访期维持。结论:认知和眼动脱敏疗法对肝癌所致的创伤后应激障碍患者具有潜在的正性干预效果,未来尚需广泛的实证研究。     

颅脑损伤后创伤后应激障碍的研究进展

创伤后应激障碍(PTSD)是临床上常见的应激后反应,多见于重大创伤后,具有发病率高、临床表现复杂、治疗难度大等特点,已成为世界范围内广泛关注的公共卫生问题。颅脑损伤是引起PTSD的重要因素,近年来针对颅脑损伤后PTSD展开了一系列研究。本文通过回顾近年来有关颅脑损伤后PTSD的基础与临床研究,对颅脑损伤与PTSD相关性的流行病学特征、发病机制、诊断与鉴别以及药物和心理治疗中的进展和面临的困难进行综述,以期为颅脑损伤后PTSD的深入研究提供理论依据和新思路。     

汶川地震救援人员创伤后应激反应特征的初步研究

目的:探讨5.12汶川地震军队救援人员创伤后应激损伤状况。方法:采用创伤后压力诊断量表、焦虑自评量表、抑郁自评量表和匹兹堡睡眠质量问卷,在地震爆发后65天左右,对107名执行运输遗体任务的官兵进行了测量。结果:PTSD症状轻度的占84%,中重度的占15%。其中症状在1个月内消失的占63%。从症状的分布来看,闯入性回忆占36.4%,回避29.9%,过度警觉29.9%,焦躁不安或易怒37.4%,入睡困难、睡眠易醒或早醒43.9%,难以集中注意力45.8%,对重要的活动兴趣下降32.7%。救援人员抑郁症状得分低于全国常模水平;焦虑自评量表得分与全国常模差异不显著。睡眠质量差的占72%,以入睡时间长和日间功能降低为主。结论:担任遗体运输的救援官兵在救援早期普遍存在创伤后应激反症状,症状程度较轻,多数在1个月内消失,焦虑和抑郁症状水平的总体状况也比较低,但普遍存在睡眠质量差的问题,并且直接影响到日间功能。     

大麻素受体参与创伤后应激障碍记忆功能损害的研究进展

创伤后应激障碍(PTSD)是个体在经历严重创伤性事件后一种迟发出现和持续存在的心理障碍,创伤相关恐惧记忆的长期持续存在是PTSD形成的重要机制。既往研究发现PTSD恐惧记忆的形成和消退与脑内神经环路的可塑性变化密切相关,大麻素受体因其在调节神经元突触可塑性中的重要作用而受到广泛关注。本文对近年来大麻素受体参与条件恐惧记忆与工作记忆调节的研究进行概述,旨在为PTSD的预防和治疗提供理论支持。     

创伤后应激障碍大鼠前额内侧皮质MR表达的变化

目的观察创伤后应激障碍(PTSD)样大鼠前额内侧皮质(medial prefrontal cortex,mPFC)神经元核受体-盐皮质激素受体(Mineralocorticoid receptors,MR)表达的变化。方法采用国际认定的单一连续应激(single prolonged stress,SPS)方法建立PTSD大鼠模型,取成年健康雄性Wistar大鼠90只,随机分为PTSD模型1d、7d、14d、28d和正常对照组。采用免疫组化、免疫印迹和RT-PCR方法分别进行各组mPFC神经元MR表达变化的观察及检测,进行图像分析和统计学处理。结果 PTSD大鼠mPFC神经元MR的表达在SPS-1d时高于对照组,随后下降,SPS-14d最低,SPS-28d恢复性上调,但仍然低于对照组(P<0.05)。结论 PTSD模型大鼠经SPS处理后,mPFC中出现MR表达的变化,该变化可能参与PTSD的下丘脑-垂体-肾上腺(hypothalamic pituitary adren axis,HPA)轴的变化机制。     

Pet Loss,Complicated Grief,and Post-Traumatic Stress Disorder in Hawaii

We examined the impact of pet/animal death on Complicated Grief (CG) and Post-Traumatic Stress Disorder (PTSD) in relation to demographic variables amongst a diverse population of racial and ethnic groups in Hawaii. Three hundred and fifty-five participants (142 solicited by mail, 213 volunteer college students) completed a 37-item questionnaire, the Inventory of Complicated Grief Revised Short Form (ICG-R-SF) and the PTSD Check-list (PCL), and we assessed relationships between demographic variables such as pet ownership with CG and PTSD scores, to gauge potential at-risk populations. While Filipino populations presented increased, if subclinical, CG and/or PTSD scores, no primary racial/ethnic identity correlated with significant scores, based on the DSM-IV-TR criteria. Individuals who scored higher on questions related to empathy with animals, such as adopting strays, feeling like their pet can sense their mood, integration of animals into the family unit, and feeling over-protective of their pet correlated with higher CG and PTSD scores. We found that 3.8% of participants met the cutoff score for CG and 5.7% met the cutoff score for PTSD, following the death of a pet/animal. There is a need for multicultural awareness regarding both human–pet/animal relationships and bereavement.     

24-Hour Pattern of Work-Related Injury Risk of French Firemen: Nocturnal Peak Time

The first aim of the study was to assess clock-time patterning of work-related injuries (WRIs) of firemen (FM) of Saône et Loire-71 (France) during the 4-yr span of 1 January 2004 to 31 December 2007. FM of this service are legally required to log every WRI and seek its evaluation by the medical service, whether the WRI was the result of worksite duties or exercise/sport activities at the station. WRI was defined specifically as a (nonexercise, nonsport, and nonemotional/stress) work-associated trauma, verified both by log book and medical records. For the corresponding years, the 24-h pattern of emergency calls (Calls) plus road traffic (Traffic) on the main roads of the service area was also assessed. Relative risk (R) of WRI was calculated as the quantity of WRIs/h divided by the quantity of Call responses/h?×?1000, which takes into account the number of at-risk FM/unit time, since each dispatched emergency vehicle is staffed with 4 FM. Comparably trained regular (RFM) and volunteer (VFM) FM experienced a total of 187 WRIs. The 24-h WRI curve patterns of RFM and VFM were correlated (r?=?0.4, p?<?.05), with no histogram difference (p?>?.05). Analysis of variance (ANOVA) validated comparable clock-time patterns in WRIs of RFM and VFM each year and each season (all p?<?.0001). Thus, time series of the RFM and VFM were pooled, revealing a statistical significant 24-h variation in WRIs (ANOVA, p?>?.0006; Cosinor analysis, p?<?.0001), with peak at 16:00?h and trough at 04:00?h. The 24-h pattern in Traffic, which mirrors that of human activity, with peak ～18:00?h and trough ～03:00?h, was also verified (ANOVA, p <?.0001; Cosinor, p?<?.0001). Calls (n?=?112,059) resulting in FM responses also exhibited statistically significant 24-h variation, with peak at ～20:00?h and trough at ～06:00?h. The 24-h pattern of R showed a nocturnal peak at 02:00?h (R?=?2.87?±?0.46; mean?±?SEM) and diurnal trough 14:00?h (R?=?1.30?±?0.05) (t test, p?<?.02); clock-time-related changes in R were further validated by ANOVA (p?=?.0001) and Cosinor (p?<?.0001), with acrophase (peak time, Ø) of 02:43?h?±?68?min (SD). The second aim of the study was to evaluate the relationship between the 24-h patterns of WRIs and lag-time (LT) response (used as a measure of work performance) of FM of the same service to urgent medical calls for out-of-hospital cardiac arrests. Highest R of WRI at 02:00?h corresponded closely to longest LT (raw data at ～02:00?h and Cosinor derived Ø of 02.54?h?±?71?min [SD]), thereby supporting the hypothesis of a common mechanism underlying the two 24-h profiles. A third aim was to determine the relevance of a new concept in work safety, “chronoprevention,” for future FM training programs. (Author correspondence: bergarein@yahoo.fr)     

Exacerbated Headache-Related Pain in the Single Prolonged Stress Preclinical Model of Post-traumatic Stress Disorder

Chronic headache pain is one of the most commonly reported comorbid pain conditions with post-traumatic stress disorder (PTSD) patients and resistant to effective treatment, yet no combined preclinical model of the two disorders has been reported. Here, we used a modified chronic headache pain model to investigate the contribution of single prolonged stress (SPS) model of PTSD with sodium nitroprusside (SNP)-induced hyperalgesia. Injection of SNP (2 mg/kg, i.p.) occurred every other day from day 7 to day 15 after initiation of SPS in rats. Paw withdrawal threshold (PWT) to von Frey stimuli and tail flick latencies (TFL) dramatically decreased as early as 7 days after SPS and lasted until at least day 21. Basal PWT and TFL also significantly decreased during the SNP treatment period. The lower nociceptive thresholds recovered in 6 days following the final SNP injection in SNP group, but not in SPS?+?SNP group. Elevated nociceptin/OFQ (N/OFQ) levels observed in cerebrospinal fluid of SPS rats were even higher in SPS?+?SNP group. Glial fibrillary acidic protein (GFAP) and N/OFQ peptide (NOP) receptor mRNA expression increased in dorsal root ganglia (DRG) 21 days after SPS exposure; mRNA increases in the SPS/SNP group was more pronounced than SPS or SNP alone. GFAP protein expression was upregulated in trigeminal ganglia by SPS. Our results indicate that traumatic stress exaggerated chronic SNP-induced nociceptive hypersensitivity, and that N/OFQ and activated satellite glia cells may play an important role in the interaction between both conditions.

     

24-hour Pattern in Lag Time of Response by Firemen to Calls for Urgent Medical Aid

The aim of the study was to assess the group 24-h pattern of lag time (LT) in response by regular and volunteer firemen (RFM and VFM) to calls for medical help (CFMH), specifically calls for out-of-hospital cardiac arrest (OHCA). LT, duration in min between a CFMH and departure of service vehicle equipped with a semiautomated defibrillator and generally staffed with four well-trained and ready-to-go FM, represents the integrated duration of several processes, each with separate reaction and decision-making times. The exact time of each CFHM (in min, h, day, month, yr) was recorded electronically, and the exact departure time from the station of the responding FM vehicle was recorded by an on-duty FM. Overall, CFMH made up 53?±?9% (SEM) of all emergencies calls for aid. To standardize the study methods, the reported findings are based on 568 CFMH specifically regarding OHCA that occurred during the 4-yr study span (January 2005 to December 2008). CFMH exhibited a 24-h pattern with a major peak at 10:00?h (mean?±?SEM: n?=?9.5?±?1.6) and major trough at 01:00?h (n?=?1.3?±?0.3; t test, p?<?.001). From year to year and season to season, a 24-h pattern was detected in the total of CFMH/h with two peaks (～10:00 and ～17:00h) and two troughs (～01:00 and ～15:00?h) (analysis of variance [ANOVA], p?<?.01; Cosinor, p?<?.05 to?<?.003), with neither season- nor year-related differences (χ², p?>?.05). In CFMH/h pooled time series, ANOVA-detected differences between the hourly means (p?<?.01), and Cosinor analysis validated a 24-h rhythm (p?<?.002). In raw data, the longest LT, indicative of poorest performance, occurred at 05:00?h (8.8?±?0.7?min) and the trough of LT, indicative of best performance, at 16:00?h (4.3?±?0.8?min (t test, p?<?.02). 24-h patterning in LT was validated both by ANOVA of hourly means (p?<?.0006) and Cosinor analysis (p?<?.05), with longest LT ～05:00?h and shortest LT ～16.00?h for data of the individual yearly time-series data. The 24-h LT rhythm was also validated in the pooled time series by Cosinor (p?<?.0001), with the 24-h mean?±?SEM?=?6?±?0.17?min and acrophase (peak) of 03:00?h?±?88?min (SD). Curve patterns of CFMH/h and LT/h differed widely. As a group phenomenon, the LT 24-h rhythm mimics the 24-h pattern of performance, as demonstrated by many laboratory and field investigations. The stability of the LT rhythm between years and seasons and its weak relationship with the CFMH 24-h pattern favors the hypothesis of an endogenous component or origin. The nighttime trough of performance is presumably linked to the elevated risk of work accidents in the same population of FM.     

非侵入性脑刺激应用于创伤后应激障碍和物质滥用障碍的记忆干预

记忆是进行思维、想象等高级心理活动的基础，是累积经验、促进个体生存的重要功能。然而，创伤后应激障碍和物质滥用障碍具有某种非适应性记忆过强的特征，不利于个体生存。因此，以病理性改变的记忆为靶点，通过削弱或更新非适应性记忆，可以达到缓解症状甚至治愈的目的。记忆并非是对经验的刻板记录，而是对经验不断更新整合的过程，因此记忆有被干预的可能。记忆的再次激活可能会诱发记忆消退和再巩固，这为记忆相关精神疾病的干预提供了思路和启发。非侵入性脑刺激（noninvasive brain stimulation,NIBS）技术作为一种时间、空间分辨率较高的无创神经调控技术，近年来开始被结合运用到记忆干预研究中。不同刺激参数的NIBS （如频率、极性，以及受刺激区域的初始神经激活状态）应用于特定大脑皮质区域，可以调节神经可塑性，增强或降低靶点脑区的兴奋性，从而削弱或增强行为表现，实现记忆消退增强或在再巩固时间窗内干预记忆。本文首先介绍了记忆相关的脑功能基础研究与局部脑区干预方案的理论联系，继而回顾了近年来NIBS与记忆干预相结合应用于创伤或物质滥用相关障碍的临床干预研究，为精神疾病临床诊疗提供理论依据和启发。     

Dysfunction and Post-Traumatic Stress Disorder in Fracture Victims 50 Months after the Sichuan Earthquake

Background

This study aimed to evaluate the effectiveness of a rehabilitation intervention on physical dysfunction (PDF) and post-traumatic stress disorder (PTSD) in fracture victims 50 months after the Sichuan earthquake of 2008 and to identify risk factors for PTSD.

Methods

This is a retrospective cohort study. Four hundred and fifty-nine earthquake-related fracture victims from Mianzhu city, Sichuan Province who did not qualify for disability pension participated. Two hundred and forty-five subjects received regular rehabilitation and 214 did not. Muscle strength, joint range of motion (ROM),sensory function, and sit-to-stand balance capacity were evaluated to assess PDF. The PTSD Checklist-Civilian Version (PCL-C) was administered to screen for PTSD. An ordinary least square regression was used to predict PTSD, and a logistic regression was used to predict PDF. In addition a Least Angle Regression (LARS) was carried out for PTSD to study the effects of rehabilitation and PDF at the same time.

Results

Unadjusted and adjusted group differences in physical dysfunction (p<0.01) and PTSD prevalence (p<0.05) were significant in favor of the rehabilitation group. In addition, being female, average or above family income, having witnessed death and fearfulness were found risk factors for PTSD symptoms 50 months after the earthquake. Both PDF and rehabilitation were selected predictors by LARS demonstrating opposite effects.

Conclusion

PDF and PTSD were significantly reduced by the rehabilitation intervention. Future medical intervention strategies should consider rehabilitation in order to assist survivors in dealing with both physical and psychological effects of natural disaster.