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Ghițan AF, Gheorman V, Ciurea ME, Gheorman V, Dinescu VC, Ciurea AM, Militaru F, Popa R, Țenea-Cojan TȘ, Udriștoiu I. Exploring the Prevalence of PTSD in Hand Trauma: A Comprehensive Study. Brain Sci 2023; 13:1438. [PMID: 37891807 PMCID: PMC10605642 DOI: 10.3390/brainsci13101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Hand trauma is a common and debilitating condition that can have significant physical, functional, and psychological effects on individuals. This study used a case-control design to investigate the frequency and factors associated with symptoms of post-traumatic stress disorder (PTSD) in a sample of individuals with complex hand and forearm injuries. Our hypothesis suggests that demographic data, among other factors, influences the intensity of PTSD symptoms measured by the PCL-5 scale three months post-surgery. This study included 166 individuals, 142 males and 24 females, with an average age of 42.14 years (SD = 12.71). Our study found significant associations between symptoms of PTSD and various demographic and clinical factors. PTSD symptoms were observed in females, individuals from specific regions, and certain socio-professional groups. Furthermore, educational attainment and personal background have been identified as significant factors in the development of PTSD. The role of trauma type was crucial, amputees and fractures were more prone to developing PTSD. A strong link was found between increased symptoms of PTSD and negative postoperative outcomes, including amputation of necessity and the need for additional surgery. The absence of family support exacerbates the psychological distress of trauma survivors. The findings highlight the intricate nature of PTSD development and underscore the significance of a comprehensive postoperative treatment strategy encompassing psychological assessment and support.
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Affiliation(s)
| | - Veronica Gheorman
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Marius Eugen Ciurea
- Department of Plastic Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (F.M.); (I.U.)
| | - Venera Cristina Dinescu
- Department of Health Promotion and Occupational Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ana Maria Ciurea
- Department of Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Felicia Militaru
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (F.M.); (I.U.)
| | - Romeo Popa
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | - Ion Udriștoiu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (F.M.); (I.U.)
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Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med 2022; 18:2291-2312. [PMID: 35678060 PMCID: PMC9435330 DOI: 10.5664/jcsm.10074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
Scientific evidence that acute, posttrauma sleep disturbances (eg, nightmares and insomnia) can contribute significantly to the pathogenesis of trauma-induced disorders is compelling. Sleep disturbances precipitating from trauma are uniquely predictive of daytime posttrauma symptom occurrence and severity, as well as subsequent onset of mental health disorders, including post-traumatic stress disorder. Conversely, adequate sleep during the acute posttrauma period is associated with reduced likelihood of adverse mental health outcomes. These findings, which are broadly consistent with what is known about the role of sleep in the regulation of emotion, suggest that the acute posttrauma period constitutes a "window of opportunity" during which treatment of sleep disturbances may be especially effective for preventing or mitigating progression of aberrant psychophysiological processes. At this point, the weight of the scientific evidence supporting this possibility warrants initiation of clinical trials to confirm the benefits of targeted prophylactic sleep enhancement, and to establish treatment guidelines as appropriate. CITATION Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med. 2022;18(9):2291-2312.
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Affiliation(s)
- Kevin M. Swift
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Connie L. Thomas
- Department of Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Emily G. Lowery-Gionta
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Liana M. Matson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Arora D, Belsiyal CX, Rawat VS. Prevalence and determinants of posttraumatic stress disorder and depression among survivors of motor vehicle accidents from a hilly Indian state. Indian J Psychiatry 2021; 63:250-257. [PMID: 34211218 PMCID: PMC8221207 DOI: 10.4103/psychiatry.indianjpsychiatry_1059_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/24/2020] [Accepted: 05/30/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite apparent. With a significant focus of treatment on physical health, psychological consequences linked to these traumas are often neglected. AIM The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well as the determinants of these disorders among survivors of MVAs. MATERIALS AND METHODS An institution-based, cross-sectional descriptive study was conducted among 250 survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total enumerative sampling. Data were collected with standardized and validated tools that consisted of sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean percentage) and inferential statistics (Mann-Whitney, Kruskal-Wallis, and binary logistic regression). RESULTS The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio [OR] = 5.52; 95% confidence interval [CI] = 0.92-3.06), loss of valuables (OR = 2.62; 95% CI = 0.78-9.04), self-blame (OR = 6.06; 95% CI = 1.15-31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89-46.85) acted as determinants in the occurrence of PTSD and depression. CONCLUSION A considerably large proportion of the population suffered from psychiatric disorders following the trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental health services across all hospitals' trauma units.
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Affiliation(s)
- Deeksha Arora
- College of Nursing, AIIMS, Rishikesh, Uttarakhand, India
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Bakker LP, Eriksen S, Reichelt JG, Grov EK. The experiences of dealing with consequences of an avalanche - surviving soldiers' perspectives. Int J Qual Stud Health Well-being 2019; 14:1689066. [PMID: 31713468 PMCID: PMC6853213 DOI: 10.1080/17482631.2019.1689066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose: The aim of the study was to explore and describe experiences of daily life after having experienced an avalanche three decades ago.Method: This paper presents a qualitative study of 12 male survivors of an avalanche during their military service, interviewed 30 years post-disaster.Findings: A comprehensive understanding of the categories led to the latent theme "Finding my own way of managing and dealing with life". Findings revealed three categories describing experiences of daily living: (i) A comfortable life; (ii) A challenging, yet accomplished life; (iii) A demanding life. The first category represents a greater degree of using adaptive coping strategies for managing everyday life compared to the other two categories. The third category represents the group having the most challenging consequences. Among the three, the latter category conveys the most maladaptive coping strategies.Conclusions:The participants had different experiences with regards to their health and how they coped with their everyday life after the avalanche disaster. Insights into coping strategies may provide a guide for appropriate interventions for survivors dealing with traumatic events.
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Affiliation(s)
- Lars-Petter Bakker
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, Oslo, Norway
| | - Siren Eriksen
- Faculty of Health Studies, Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway, and VID Specialized university, Oslo, Norway
| | - Jon Gerhard Reichelt
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Fekadu W, Mekonen T, Belete H, Belete A, Yohannes K. Incidence of Post-Traumatic Stress Disorder After Road Traffic Accident. Front Psychiatry 2019; 10:519. [PMID: 31379631 PMCID: PMC6659351 DOI: 10.3389/fpsyt.2019.00519] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) occurs after exposure to actual or threatened death, serious injury, or sexual violence. Road traffic accident (RTA) is one of the traumatic experiences, which may result in PTSD. But treatment is mainly concentrated on physical health. This may be due to a lack of evidence in low-income countries. Aim: To determine the incidence level and identify risk factors of PTSD after RTA. Methods: Longitudinal panel study was done to assess the incidence of PTSD after RTA. The study was conducted in three orthopedic settings of Bahir Dar town Northwest, Ethiopia. The study was on 299 adult car accident survivors. PTSD Checklist (PCL) civilian version, Sheehan disability assessment scale, Patient Health Question (PHQ-2), and Alcohol Use Disorder Identification Test (AUDIT) were instruments to assess the outcome and associated factors. The generalized linear model with Poisson log-linear method was applied to identify associated factors. Ethical clearance was obtained from Bahir Dar University. Individuals with PTSD symptoms were linked to the psychiatric clinic. Result: One hundred thirty-nine (46.5%) participants had at least three extremely severe symptoms that fulfil criteria B, C, and D of Diagnostic Statistical Manual IV of PTSD. The most frequent severe symptoms were having repeated, disturbing memories, thoughts, or images. Two hundred ten (70.2%) participants reported the extreme impact of the accident on work or schooling and 156 (51.9%) reported extreme problems in social functioning. Alcohol dependence, hazardous alcohol consumption, and harmful use were reported by 7.9%, 15.1%, and 4.7% of the participants, respectively. In the final model witnessing death, severe sleep problem and severe impairment in family functioning were significantly associated with PTSD. Conclusion: Nearly half of RTA survivors develop PTSD. Clinicians need to link these patients to the psychiatry clinic. Special attention should be given to patients who witnessed death, with a serious disability, and previous psychiatric history.
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Affiliation(s)
- Wubalem Fekadu
- Psychiatry Department, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Psychiatry Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfa Mekonen
- Psychiatry Department, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habte Belete
- Psychiatry Department, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amsalu Belete
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Dilla, Ethiopia
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Bakker LP, Småstuen MC, Reichelt JG, Gjerstad CL, Tønnessen A, Weisæth L, Herlofsen PH, Grov EK. The trajectory of symptom burden in exposed and unexposed survivors of a major avalanche disaster: a 30 year long-term follow-up study. BMC Psychiatry 2019; 19:175. [PMID: 31182052 PMCID: PMC6558916 DOI: 10.1186/s12888-019-2159-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Limited research exists concerning the long-term effects of avalanches on survivors' mental health beyond the first years after the accident. The aims of this study were to describe and evaluate possible differences in long-term mental health symptoms after a major avalanche disaster between exposed and unexposed soldiers using a longitudinal design. METHOD Present mental health symptoms were examined among avalanche exposed (n = 12) and unexposed (n = 9) soldiers by PTSS-10, IES-15 and STAI-12 in four waves (1986-1987 and 2016). RESULTS Binary logistic regression revealed that the odds to score above the cut-off were significantly lower for both groups after one year compared to baseline for PTSS-10 (p = 0.018) and significantly lower after 30 days compared to baseline for IES-15 (p = 0.005). Data did not reveal significant differences between the exposed and unexposed groups regarding adjusted PTSS-10, IES-15 or STAI-12 mean scores compared. Linear mixed model-analyses revealed significant effects of time. The adjusted mean scores declined over time for both groups: PTSS-10 (p = 0.001), IES-15 (p = 0.026) and STAI-12 (p = 0.001), and the time trajectories for PTSS-10 were significantly different between the groups (p = 0.013). Although not significant (all p > 0.05), results indicated that a larger proportion of soldiers in the exposed group experienced posttraumatic stress symptoms (5/12) (PTSS-10 score ≥ 4) and distress symptoms (6/12) (IES-15 score ≥ 26) above cut-off points, 30 years post-disaster. CONCLUSIONS The course of mental health symptoms may persist, and even increase, in selected and trained military personnel 30 years after exposure to a natural disaster. These findings may be of great importance for health authorities planning appropriate follow-up.
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Affiliation(s)
- Lars-Petter Bakker
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015, Oslo, Norway.
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Jon Gerhard Reichelt
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015 Oslo, Norway
| | - Christer Lunde Gjerstad
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015 Oslo, Norway
| | - Arnfinn Tønnessen
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015 Oslo, Norway
| | - Lars Weisæth
- 0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Gaustad sykehus. Bygg 4, PO Box 1039, N-0315 Oslo, Blindern Norway
| | | | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, N-0130 Oslo, Norway
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Qi W, Ratanatharathorn A, Gevonden M, Bryant R, Delahanty D, Matsuoka Y, Olff M, deRoon-Cassini T, Schnyder U, Seedat S, Laska E, Kessler RC, Koenen K, Shalev A. Application of data pooling to longitudinal studies of early post-traumatic stress disorder (PTSD): the International Consortium to Predict PTSD (ICPP) project. Eur J Psychotraumatol 2018; 9:1476442. [PMID: 29938009 PMCID: PMC6008580 DOI: 10.1080/20008198.2018.1476442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Understanding the development of post-traumatic stress disorder (PTSD) is a precondition for efficient risk assessment and prevention planning. Studies to date have been site and sample specific. Towards developing generalizable models of PTSD development and prediction, the International Consortium to Predict PTSD (ICPP) compiled data from 13 longitudinal, acute-care based PTSD studies performed in six different countries. Objective: The objectives of this study were to describe the ICPP's approach to data pooling and harmonization, and present cross-study descriptive results informing the longitudinal course of PTSD after acute trauma. Methods: Item-level data from 13 longitudinal studies of adult civilian trauma survivors were collected. Constructs (e.g. PTSD, depression), measures (questions or scales), and time variables (days from trauma) were identified and harmonized, and those with inconsistent coding (e.g. education, lifetime trauma exposure) were recoded. Administered in 11 studies, the Clinician Administered PTSD Scale (CAPS) emerged as the main measure of PTSD diagnosis and severity. Results: The pooled data set included 6254 subjects (39.9% female). Studies' average retention rate was 87.0% (range 49.1-93.5%). Participants' baseline assessments took place within 2 months of trauma exposure. Follow-up durations ranged from 188 to 1110 days. Reflecting studies' inclusion criteria, the prevalence of baseline PTSD differed significantly between studies (range 3.1-61.6%), and similar differences were observed in subsequent assessments (4.3-38.2% and 3.8-27.0% for second and third assessments, respectively). Conclusion: Pooling data from independently collected studies requires careful curation of individual data sets for extracting and optimizing informative commonalities. However, it is an important step towards developing robust and generalizable prediction models for PTSD and can exceed findings of single studies. The large differences in prevalence of PTSD longitudinally cautions against using any individual study to infer trauma outcome. The multiplicity of instruments used in individual studies emphasizes the need for common data elements in future studies.
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Affiliation(s)
- Wei Qi
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York , USA
| | - Martin Gevonden
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Richard Bryant
- Faculty of Science, University of New South Wales School of Psychology, Kensington, Australia
| | - Douglas Delahanty
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Yutaka Matsuoka
- Division of Health Care Research, National Cancer Center, Center for Public Health Sciences, Tokyo, Japan
| | - Miranda Olff
- Department of Psychiatry, University of Amsterdam Academic Medical Center, Amsterdam-Zuidoost, The Netherlands
| | | | - Ulrich Schnyder
- Department of Psychiatry, University of Zurich School of Medicine, Zurich, Switzerland
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University School of Medicine and Health Sciences, Cape Town, South Africa
| | - Eugene Laska
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan Koenen
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Arieh Shalev
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
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Lisieski MJ, Eagle AL, Conti AC, Liberzon I, Perrine SA. Single-Prolonged Stress: A Review of Two Decades of Progress in a Rodent Model of Post-traumatic Stress Disorder. Front Psychiatry 2018; 9:196. [PMID: 29867615 PMCID: PMC5962709 DOI: 10.3389/fpsyt.2018.00196] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a common, costly, and often debilitating psychiatric condition. However, the biological mechanisms underlying this disease are still largely unknown or poorly understood. Considerable evidence indicates that PTSD results from dysfunction in highly-conserved brain systems involved in stress, anxiety, fear, and reward. Pre-clinical models of traumatic stress exposure are critical in defining the neurobiological mechanisms of PTSD, which will ultimately aid in the development of new treatments for PTSD. Single prolonged stress (SPS) is a pre-clinical model that displays behavioral, molecular, and physiological alterations that recapitulate many of the same alterations observed in PTSD, illustrating its validity and giving it utility as a model for investigating post-traumatic adaptations and pre-trauma risk and protective factors. In this manuscript, we review the present state of research using the SPS model, with the goals of (1) describing the utility of the SPS model as a tool for investigating post-trauma adaptations, (2) relating findings using the SPS model to findings in patients with PTSD, and (3) indicating research gaps and strategies to address them in order to improve our understanding of the pathophysiology of PTSD.
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Affiliation(s)
- Michael J Lisieski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Andrew L Eagle
- Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - Alana C Conti
- Research and Development Service, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, United States.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Shane A Perrine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
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Szabo YZ, Warnecke AJ, Newton TL, Valentine JC. Rumination and posttraumatic stress symptoms in trauma-exposed adults: a systematic review and meta-analysis. ANXIETY STRESS AND COPING 2017; 30:396-414. [DOI: 10.1080/10615806.2017.1313835] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Yvette Z. Szabo
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Ashlee J. Warnecke
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Tamara L. Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Jeffrey C. Valentine
- Department of Educational and Counseling Psychology, University of Louisville, Louisville, KY, USA
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Fraser F, Matsuzawa Y, Lee YSC, Minen M. Behavioral Treatments for Post-Traumatic Headache. Curr Pain Headache Rep 2017; 21:22. [PMID: 28283812 DOI: 10.1007/s11916-017-0624-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Post-traumatic headache (PTH) is a common headache type after traumatic brain injury (TBI). There are no FDA approved medications for PTH, and it is unknown how medications can affect the brain's ability to recover from TBI. Thus, we sought to examine the biopsychosocial factors that influence PTH and the non-pharmacologic treatments studied for headache treatment. We also sought to determine if there is literature examining whether the non-pharmacologic treatments influence the biopsychosocial factors. The non-pharmacologic treatments assessed included cognitive behavioral therapy (CBT), biofeedback, progressive muscle relaxation therapy (PMR), acupuncture, and physical therapy (PT). RECENT FINDINGS Factors associated with prognosis in PTH may include the following: severity of TBI, stress, post-traumatic stress disorder, other psychiatric comorbidities, sociocultural and psychosocial factors, litigation, base rate misattribution, expectation as etiology, and chronic pain. There are few high quality studies on the non-pharmacologic treatments for PTH. Thermal and EMG biofeedback appear to have been examined the most followed by CBT. Studies did not have secondary outcomes examining the psychosocial factors related to PTH. Most of the behavioral studies involved a multi-modality intervention limiting the ability to assess the individual non-pharmacologic interventions we sought to study. There were very few randomized clinical trials evaluating the efficacy of non-pharmacologic interventions. Therefore, future research, which considers the noted biopsychosocial factors, is needed in the field to determine if these interventions reduce PTH.
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Affiliation(s)
- Felicia Fraser
- Rusk Rehabilitation, NYU Langone Medical Center, New York City, USA
| | - Yuka Matsuzawa
- Rusk Rehabilitation, NYU Langone Medical Center, New York City, USA
| | | | - Mia Minen
- Department of Neurology, NYU Langone Medical Center, 240 East 38th Street 20th floor, NY, NY, 10016, USA.
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Skogstad L, Hem E, Sandvik L, Ekeberg O. Nurse-led psychological intervention after physical traumas: a randomized controlled trial. J Clin Med Res 2015; 7:339-47. [PMID: 25780483 PMCID: PMC4356095 DOI: 10.14740/jocmr2082w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Emergency room nurses were trained to provide a short-term psychological intervention in physically injured patients with Impact of Event Scale (IES) scores > 20. The aims were to study the effects of the psychological intervention relative to usual care (UC). METHODS In a randomized controlled trial, psychological distress, daily functioning and the personality traits optimism/pessimism were compared with patients who received the UC. The interventions were provided 1 - 3 months after discharge. RESULTS The IES scores were significantly reduced in both groups at 3 months (intervention: 41.1 - 28.6, P < 0.001 vs. UC: 35.4 - 26.2, P < 0.001), but not significantly different between groups. Baseline IES score was a significant predictor of IES scores at 3 (β = 0.4, P < 0.05) and 12 months (β = 0.3, P < 0.05), whereas overall daily functioning at 3 months predicted IES scores at 12 months (β = -0.5, P < 0.001). Patients receiving intervention became significantly more optimistic during the year, and had an increase in overall daily functioning from 3 to 12 months (P < 0.001). Patients declining intervention were more pessimistic and had lower daily functioning. Patients who talked with nurses with more training in psychological processing had a larger reduction in IES symptoms at 3 months (β = -0.3, P = 0.081). CONCLUSION The nurse-led intervention had a significant effect on optimism and overall daily functioning. Nurses may become a low-cost option to perform short-term psychological interventions with physically injured hospitalized patients.
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Affiliation(s)
- Laila Skogstad
- Department of Research and Development, Division of Critical Care, Oslo University Hospital, Ulleval, Oslo, Norway ; Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Erlend Hem
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Leiv Sandvik
- Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Oivind Ekeberg
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway ; Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Williams JL, Rheingold AA, Knowlton AW, Saunders BE, Kilpatrick DG. Associations between motor vehicle crashes and mental health problems: data from the National Survey of Adolescents-Replication. J Trauma Stress 2015; 28:41-8. [PMID: 25613484 PMCID: PMC4347895 DOI: 10.1002/jts.21983] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Motor vehicle crashes (MVCs) are a leading cause of physical injuries and mortality among children and adolescents in the United States. The purpose of this study was to examine associations between having an MVC and mental health outcomes, including posttraumatic stress disorder (PTSD), depression, and drug and alcohol misuse in a nationally representative sample of adolescents. A sample of 3,604 adolescents, aged 12-17 years, was assessed as part of the 2005 National Survey of Adolescents-Replication (NSA-R) study. Data were weighted according to the 2005 U.S. Census estimates. Within this sample, 10.2% of adolescents reported having at least 1 serious MVC. The prevalence of current PTSD and depression among adolescents having an MVC was 7.4% and 11.2%, respectively. Analyses revealed that an MVC among adolescents aged 15 years and younger was independently associated with depression (OR = 2.17) and alcohol abuse (OR = 2.36) after adjusting for other risk factors, including a history of interpersonal violence. Among adolescents aged 16 years and older, an MVC was associated only with alcohol abuse (OR = 2.08). This study was the first attempt to explore adverse mental health outcomes associated with MVCs beyond traumatic stress symptoms among adolescents in a nationally representative sample.
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Affiliation(s)
- Joah L Williams
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Oflaz S, Yüksel Ş, Şen F, Özdemiroğlu F, Kurt R, Oflaz H, Kaşikcioğlu E. Does Illness Perception Predict Posttraumatic Stress Disorder in Patients with Myocardial Infarction? Noro Psikiyatr Ars 2014; 51:103-109. [PMID: 28360608 DOI: 10.4274/npa.y6394] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 09/12/2012] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Myocardial infarction (MI) as a life-threatening event, carrying high risk of recurrence and chronic disabling complications, increases the risk of developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or both. The aim of this study was to investigate the relationship between illness perceptions and having ASD, PTSD, or both in patients after MI. METHOD Seventy-six patients diagnosed with acute MI were enrolled into our prospective study. We evaluated patients during the first week and six months after MI. Patients were assessed by using the Clinician Administered PTSD Scale (CAPS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Brief Illness Perception Questionnaire (BIPQ), and a semi-structured interview for socio-demographic characteristics during both the first and second evaluations. RESULTS Acute stress disorder (ASD) developed in 9.2% of patients and PTSD developed in 11.9% of patients with MI. Illness perception factors of 'consequences, identity and concern' predicted the occurrence of both ASD and PTSD, whereas 'emotion' predicted only PTSD. CONCLUSION The factors of illness perceptions predicted the induction of ASD and PTSD in patients who had acute MI.
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Affiliation(s)
- Serap Oflaz
- İstanbul University Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey
| | - Şahika Yüksel
- İstanbul University Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey
| | - Fatma Şen
- İstanbul University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | | | - Ramazan Kurt
- Marmara University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Hüseyin Oflaz
- İstanbul University Faculty of Medicine, Department of Cardiology, İstanbul, Turkey
| | - Erdem Kaşikcioğlu
- İstanbul University Faculty of Medicine, Department of Sports Medicine, İstanbul, Turkey
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Ghisi M, Novara C, Buodo G, Kimble MO, Scozzari S, Di Natale A, Sanavio E, Palomba D. Psychological distress and post-traumatic symptoms following occupational accidents. Behav Sci (Basel) 2013; 3:587-600. [PMID: 25379258 PMCID: PMC4217600 DOI: 10.3390/bs3040587] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/15/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022] Open
Abstract
Depression and post-traumatic stress disorder frequently occur as a consequence of occupational accidents. To date, research has been primarily focused on high-risk workers, such as police officers or firefighters, and has rarely considered individuals whose occupational environment involves the risk of severe, but not necessarily life-threatening, injury. Therefore, the present study was aimed at assessing the psychological consequences of accidents occurring in several occupational settings (e.g., construction and industry). Thirty-eight victims of occupational accidents (injured workers) and 38 gender-, age-, and years of education-matched workers who never experienced a work accident (control group) were recruited. All participants underwent a semi-structured interview administered by a trained psychologist, and then were requested to fill in the questionnaires. Injured workers reported more severe anxious, post-traumatic and depressive symptoms, and poorer coping skills, as compared to controls. In the injured group low levels of resilience predicted post-traumatic symptomatology, whereas the degree of physical injury and the length of time since the accident did not play a predictive role. The results suggest that occupational accidents may result in a disabling psychopathological condition, and that a brief psychological evaluation should be included in the assessment of seriously injured workers.
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Affiliation(s)
- Marta Ghisi
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy; E-Mails: (C.N.); (G.B.); (S.S.); (A.D.N.); (E.S.); (D.P.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-049-827-6037 (ext. 37014); Fax: +39-049-827-6600
| | - Caterina Novara
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy; E-Mails: (C.N.); (G.B.); (S.S.); (A.D.N.); (E.S.); (D.P.)
| | - Giulia Buodo
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy; E-Mails: (C.N.); (G.B.); (S.S.); (A.D.N.); (E.S.); (D.P.)
| | - Matthew O. Kimble
- Department of Psychology, Middlebury College, McCardell Bicentennial Hall, 276 Bicentennial Way, Middlebury, VT 05753, USA; E-Mail:
| | - Simona Scozzari
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy; E-Mails: (C.N.); (G.B.); (S.S.); (A.D.N.); (E.S.); (D.P.)
| | - Arianna Di Natale
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy; E-Mails: (C.N.); (G.B.); (S.S.); (A.D.N.); (E.S.); (D.P.)
| | - Ezio Sanavio
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy; E-Mails: (C.N.); (G.B.); (S.S.); (A.D.N.); (E.S.); (D.P.)
| | - Daniela Palomba
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy; E-Mails: (C.N.); (G.B.); (S.S.); (A.D.N.); (E.S.); (D.P.)
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The course of posttraumatic stress symptoms and functional impairment following a disaster: what is the lasting influence of acute versus ongoing traumatic events and stressors? Soc Psychiatry Psychiatr Epidemiol 2013; 48:385-95. [PMID: 22878832 PMCID: PMC3504624 DOI: 10.1007/s00127-012-0560-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Ongoing traumatic events and stressors, rather than acute sources of trauma, may shape long-term post-disaster mental health. The purpose of this study was to compare the influence of acute hurricane-related exposures and ongoing post-hurricane exposures on the short- and long-term course of posttraumatic stress symptoms (PTSS) and functional impairment (FI). METHODS A random sample of adults (n = 658) in Galveston and Chambers Counties, Texas, was selected 2-6 months after Hurricane Ike and interviewed 3 times over 18 months. Hurricane-related exposures included traumatic events such as death of a family member due to the hurricane and stressors such as loss/damage to personal property due to the hurricane. Post-hurricane exposures included traumatic events such as sexual assault and stressors such as divorce or serious financial problems. RESULTS Experiencing an acute hurricane-related traumatic event or stressor was associated with initial post-hurricane PTSS [RR = 1.92 (95% CI = 1.13-3.26) and RR = 1.62 (1.36-1.94), respectively] and FI [RR = 1.76; (1.05-2.97) and RR = 1.74 (1.46-2.08)], respectively, and acute hurricane-related stressors were associated with a higher rate of increase in FI over time [RR = 1.09; (1.01-1.19)]. In contrast, ongoing post-hurricane daily stressors were not associated within initial PTSS and FI, but were associated with PTSS and FI at the second and third interviews. CONCLUSIONS While immediate postdisaster interventions may influence short-term mental health, investment in the prevention of ongoing stressors may be instrumental to manage long-term mental health status.
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Morris MC, Rao U. Psychobiology of PTSD in the acute aftermath of trauma: Integrating research on coping, HPA function and sympathetic nervous system activity. Asian J Psychiatr 2013; 6:3-21. [PMID: 23380312 PMCID: PMC3565157 DOI: 10.1016/j.ajp.2012.07.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/28/2012] [Accepted: 07/30/2012] [Indexed: 12/11/2022]
Abstract
Research on the psychobiological sequelae of trauma has typically focused on long-term alterations in individuals with chronic posttraumatic stress disorder (PTSD). Far less is known about the nature and course of psychobiological risk factors for PTSD during the acute aftermath of trauma. In this review, we summarize data from prospective studies focusing on the relationships among sympathetic nervous system activity, hypothalamic-pituitary-adrenal function, coping strategies and PTSD symptoms during the early recovery (or non-recovery) phase. Findings from pertinent studies are integrated to inform psychobiological profiles of PTSD-risk in children and adults in the context of existing models of PTSD-onset and maintenance. Data regarding bidirectional relations between coping strategies and stress hormones is reviewed. Limitations of existing literature and recommendations for future research are discussed.
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Affiliation(s)
- Matthew C Morris
- Center for Molecular and Behavioral Neuroscience (MCM and UR) and the Department of Psychiatry and Behavioral Sciences (UR), Meharry Medical College, Nashville, TN 37208, United States.
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Usuki M, Matsuoka Y, Nishi D, Yonemoto N, Matsumura K, Otomo Y, Kim Y, Kanba S. Potential impact of propofol immediately after motor vehicle accident on later symptoms of posttraumatic stress disorder at 6-month follow up: a retrospective cohort study. Crit Care 2012; 16:R196. [PMID: 23075426 PMCID: PMC3682298 DOI: 10.1186/cc11681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 09/14/2012] [Accepted: 10/11/2012] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Critically injured patients are at risk of developing posttraumatic stress disorder (PTSD). Propofol was recently reported to enhance fear memory consolidation retrospectively. Thus, we investigated here whether administration of propofol within 72 h of a motor vehicle accident (MVA) affects the subsequent development of PTSD symptoms. METHODS We examined data obtained from a prospective cohort study of MVA-related injured patients, admitted to the intensive care unit of a general hospital. We investigated the effect of propofol administration within 72 h of MVA on outcome. Primary outcome was diagnosis of full or partial PTSD as determined by the Clinician-Administered PTSD Scale (CAPS) at 6 months. Secondary outcomes were diagnosis of full or partial PTSD at 1 month and CAPS score indicating PTSD at 1 and 6 months. Multivariate analysis was conducted adjusting for being female, age, injury severity score (ISS), and administration of ketamine or midazolam within 72 h of MVA. RESULTS Among 300 patients recruited (mean ISS, 8.0; median Glasgow Coma Scale (GCS) score, 15.0; age, 18 to 69 years), propofol administration showed a higher risk for full or partial PTSD as determined by CAPS at 6 months (odds ratio = 6.13, 95% confidence interval (CI): 1.57 to 23.85, P = 0.009) and at 1 month (odds ratio = 1.31, 95% CI: 0.41 to 4.23, P = 0.647) in the multivariate logistic regression. Multivariate regression analysis showed a trend toward adverse effects of propofol on PTSD symptom development at 6 months after MVA (β = 4.08, 95% CI: -0.49 to 8.64, P = 0.080), but not at 1 month after MVA (β = -0.42, 95% CI: -6.34 to 5.51, P = 0.890). CONCLUSIONS These findings suggest that using propofol in the acute phase after MVA might be associated with the development of PTSD symptoms 6 months later. However, since the design of this study was retrospective, these findings should be interpreted cautiously and further study is warranted.
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Affiliation(s)
- Masato Usuki
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- Department of Psychiatry, National Disaster Medical Center, Tokyo 190-0014, Japan
- CREST, Japan Science and Technology Agency, Tokyo 102-0075, Japan
- Department of Neuropsychiatry, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Yutaka Matsuoka
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- Department of Psychiatry, National Disaster Medical Center, Tokyo 190-0014, Japan
- CREST, Japan Science and Technology Agency, Tokyo 102-0075, Japan
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Daisuke Nishi
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- Department of Psychiatry, National Disaster Medical Center, Tokyo 190-0014, Japan
- CREST, Japan Science and Technology Agency, Tokyo 102-0075, Japan
- Department of Neuropsychiatry, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Naohiro Yonemoto
- CREST, Japan Science and Technology Agency, Tokyo 102-0075, Japan
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Kenta Matsumura
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- CREST, Japan Science and Technology Agency, Tokyo 102-0075, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Yoshiharu Kim
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
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Barak Y, Szor H. Lifelong posttraumatic stress disorder: evidence from aging Holocaust survivors. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033740 PMCID: PMC3181591 DOI: 10.31887/dcns.2000.2.1/ybarak] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite the fact that 50 years have passed since the Nazi regime and the Holocaust the psychic sequelae are far from being overcome. The majority of Holocaust survivors and World War II veterans still list their experiences as the “most significant stressors” of their lives. The literature provides ample evidence that posttraumatic stress disorder among survivors persists into old age. However, there is still a need to define the differences in frequency, clinical presentation, severity, and comorbid conditions among aging Holocaust survivors. Age at the time of trauma, cumulative lifetime stress, and physical illness are reported to have a positive association with more severe posttraumatic symptomatology. The presence of comorbid Axis i psychiatric disorders (Diagnostic and Statistical Manual [DSIVI]), has been the focus of research by our group, demonstrating that their interaction with earlier trauma leads to a course of chronic, debilitating disease. Despite reactivation of traumatic symptoms during aging and continuous mental suffering, the majority of Holocaust survivors show good instrumental coping and preserved functioning.
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Affiliation(s)
- Y Barak
- Author affiliations: The Psychogeriatric Department, Abarbanel Mental Health Center, Bat Yam; and the Sackler Faculty of Medicine, Tel Aviv University, Israel
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Armour C, Shevlin M, Elklit A, Mroczek D. A Latent Growth Mixture Modeling Approach to PTSD Symptoms in Rape Victims. TRAUMATOLOGY 2012; 18:20-28. [PMID: 22661909 PMCID: PMC3365569 DOI: 10.1177/1534765610395627] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The research literature has suggested that longitudinal changes in posttraumatic stress disorder (PTSD) could be adequately described in terms of one universal trajectory, with individual differences in baseline levels (intercept) and rate of change (slope) being negligible. However, not everyone who has experienced a trauma is diagnosed with PTSD, and symptom severity levels differ between individuals exposed to similar traumas. The current study employed the latent growth mixture modeling technique to test for multiple trajectories using data from a sample of Danish rape victims (N = 255). In addition, the analysis aimed to determine whether a number of explanatory variables could differentiate between the trajectories (age, acute stress disorder [ASD], and perceived social support). Results concluded the existence of two PTSD trajectories. ASD was found to be the only significant predictor of one trajectory characterized by high initial levels of PTSD symptomatology. The present findings confirmed the existence of multiple trajectories with regard to PTSD symptomatology in a way that may be useful to clinicians working with this population.
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Affiliation(s)
- Cherie Armour
- University of Ulster, Magee Campus, Londonderry, Northern Ireland, UK
- The National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Mark Shevlin
- University of Ulster, Magee Campus, Londonderry, Northern Ireland, UK
| | - Ask Elklit
- The National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Iteke O, Bakare MO, Agomoh AO, Uwakwe R, Onwukwe JU. Road traffic accidents and posttraumatic stress disorder in an orthopedic setting in South-Eastern Nigeria: a controlled study. Scand J Trauma Resusc Emerg Med 2011; 19:39. [PMID: 21696614 PMCID: PMC3138453 DOI: 10.1186/1757-7241-19-39] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 06/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric liaison services are rare in trauma units of various hospitals in Nigeria and other sub-Saharan African countries. The occurrence of road traffic accidents (RTAs) resulting from low standard of road construction and inadequate maintenance have been on the increase in Nigeria. While the physical consequences of such RTAs are obvious, the psychological consequences are often not apparent. This study assessed the prevalence of posttraumatic stress disorder (PTSD) among victims of RTAs and compared same with controls drawn from a population who have not experienced RTAs. It also assessed the associated socio-demographic variables. METHOD Study population consisted of one hundred and fifty RTA victims and two different control groups drawn from the population consisting of staffs of Federal Neuropsychiatric Hospital, Enugu, Nigeria and that of National Orthopedic Hospital, Enugu, Nigeria, 150 people in each control group were matched for age and sex with the RTA victims and they were interviewed with PTSD module of Mini International Neuropsychiatric Interview (MINI) and their socio-demographic variables obtained with socio-demographic questionnaire. RESULTS The prevalence of PTSD among RTA victims and the two control groups were 26.7%, 8.0% and 8.7% respectively. The difference in prevalence was statistically significant with RTA victims more likely to experience PTSD compared to the two control groups (X² = 27.23, df = 2, p = 0.001). Gender influenced the prevalence of PTSD among victims of RTAs and the controls, with females more likely to experience PTSD when compared to the males. Among victims of RTAs, being gainfully employed prior to the accidents increased the likelihood of developing PTSD and this was statistically significant (X² = 20.09, df = 1, p = 0.000). CONCLUSIONS There is urgent need to pay more attention to developing consultation-liaison psychiatry services in trauma units of Nigerian hospitals, including orthopedic hospitals located in different geographical zones of the country.
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Affiliation(s)
- Obiora Iteke
- General Adult Psychiatry Unit, Federal Neuropsychiatric Hospital, New Haven, Enugu, Enugu State, Nigeria.
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Carty J, O'Donnell M, Evans L, Kazantzis N, Creamer M. Predicting posttraumatic stress disorder symptoms and pain intensity following severe injury: the role of catastrophizing. Eur J Psychotraumatol 2011; 2:EJPT-2-5652. [PMID: 22893804 PMCID: PMC3402105 DOI: 10.3402/ejpt.v2i0.5652] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 03/31/2011] [Accepted: 04/02/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A number of theories have proposed possible mechanisms that may explain the high rates of comorbidity between posttraumatic stress disorder (PTSD) and persistent pain; however, there has been limited research investigating these factors. OBJECTIVE The present study sought to prospectively examine whether catastrophizing predicted the development of PTSD symptoms and persistent pain following physical injury. DESIGN Participants (N=208) completed measures of PTSD symptomatology, pain intensity and catastrophizing during hospitalization following severe injury, and 3 and 12 months postinjury. Cross-lagged path analysis explored the longitudinal relationship between these variables. RESULTS Acute catastrophizing significantly predicted PTSD symptoms but not pain intensity 3 months postinjury. In turn, 3-month catastrophizing predicted pain intensity, but not PTSD symptoms 12 months postinjury. Indirect relations were also found between acute catastrophizing and 12-month PTSD symptoms and pain intensity. Relations were mediated via 3-month PTSD symptoms and 3-month catastrophizing, respectively. Acute symptoms did not predict 3-month catastrophizing and catastrophizing did not fully account for the relationship between PTSD symptoms and pain intensity. CONCLUSIONS Findings partially support theories that propose a role for catastrophizing processes in understanding vulnerability to pain and posttrauma symptomatology and, thus, a possible mechanism for comorbidity between these conditions.
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Affiliation(s)
- Jessica Carty
- School of Psychological Science, La Trobe University, Melbourne, VIC, Australia
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Jubran A, Lawm G, Duffner LA, Collins EG, Lanuza DM, Hoffman LA, Tobin MJ. Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36:2030-7. [PMID: 20661726 DOI: 10.1007/s00134-010-1972-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 05/23/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify patients at risk for developing PTSD. METHODS A prospective longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation was undertaken: 72 patients were studied 1 week after weaning, and 41 patients were studied again 3 months later. An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD. To assess for the presence of PTSD-related symptoms, the post-traumatic stress syndrome (PTSS-10) questionnaire was administered 1 week after weaning and 3 months later. RESULTS The psychologist diagnosed PTSD in 12% of patients 3 months after ventilator weaning. Patients who developed PTSD were more likely to have a previous history of psychiatric disorders (P < 0.02). A PTSS-10 score >20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later: sensitivity 1.0; specificity 0.76; area under the receiver-operating characteristic curve 0.91. CONCLUSION PTSD was diagnosed in 12% of patients who were weaned from prolonged ventilation. A PTSS-10 score >20 one week after weaning identified patients diagnosed with PTSD 3 months later. This finding suggests that a simple questionnaire administered before hospital discharge can identify patients at risk for developing PTSD.
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Affiliation(s)
- Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital, Hines IL and Loyola University of Chicago Stritch School of Medicine, Maywood, IL, USA.
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Simmel S, Bühren V. [Surviving multiple trauma--what comes next? The rehabilitation of seriously injured patients]. Unfallchirurg 2010; 112:965-74. [PMID: 19816668 DOI: 10.1007/s00113-009-1686-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The survival chances of multiple trauma patients have improved continuously over the last decades. Therefore, not only the question of whether the patient survives a serious accident arises, but rather how the patient survives it. The after effects of trauma are seen not only physically, but also psychologically and socially. These affect quality of life and are evident years after the accident. The International Classification of Functioning, Disability and Health (ICF) provides a system to classify the after effects of trauma, which can be measured with the help of assessment instruments. Knowing which parameters can influence trauma after effects is essential for the planning, organization, and implementation of a rehabilitation programme following severe injury. The requirements of an optimal rehabilitation process place high demands on the rehabilitation facility and on the rehabilitation team, which ultimately can only be fulfilled by specialized facilities.
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Affiliation(s)
- S Simmel
- Abteilung für BG-Rehabilitation, BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418 Murnau.
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Bryant RA, Creamer M, O'Donnell M, Silove D, McFarlane AC. Sleep disturbance immediately prior to trauma predicts subsequent psychiatric disorder. Sleep 2010; 33:69-74. [PMID: 20120622 PMCID: PMC2802249 DOI: 10.1093/sleep/33.1.69] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY OBJECTIVES This study investigated the extent to which sleep disturbance in the period immediately prior to a traumatic event predicted development of subsequent psychiatric disorder. DESIGN Prospective design cohort study. SETTING Four major trauma hospitals across Australia. PATIENTS A total of 1033 traumatically injured patients were initially assessed during hospital admission and followed up at 3 months (898) after injury. MEASURES Lifetime psychiatric disorder was assessed in hospital with the Mini-International Neuropsychiatric Interview. Sleep disturbance in the 2 weeks prior to injury was also assessed using the Sleep Impairment Index. The prevalence of psychiatric disorder was assessed 3 months after traumatic injury. RESULTS There were 255 (28%) patients with a psychiatric disorder at 3 months. Patients who displayed sleep disturbance prior to the injury were more likely to develop a psychiatric disorder at 3 months (odds ratio: 2.44, 95% CI: 1.62-3.69). In terms of patients who had never experienced a prior disorder (n = 324), 96 patients (30%) had a psychiatric disorder at 3 months, and these patients were more likely to develop disorder if they displayed prior sleep disturbance (odds ratio: 3.16, 95% CI: 1.59-4.75). CONCLUSIONS These findings provide evidence that sleep disturbance prior to a traumatic event is a risk factor for development of posttraumatic psychiatric disorder.
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Pirente N, Blum C, Wortberg S, Bostanci S, Berger E, Lefering R, Bouillon B, Rehm KE, Neugebauer EAM. Quality of life after multiple trauma: the effect of early onset psychotherapy on quality of life in trauma patients. Langenbecks Arch Surg 2007; 392:739-45. [PMID: 17375319 DOI: 10.1007/s00423-007-0171-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 02/02/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to improve health-related quality of life (HRQOL) related to depression, anxiety, pain, physical functioning and social aspects for severely injured trauma survivors by early onset cognitive behavioural therapy applied on the surgical ward. MATERIALS AND METHODS The study was a randomised, controlled study. Of 298 primary screened patients 171 were eligible and randomised. Ninety-two patients adhered to follow-up investigations at 6 and 12 months. Main outcome measure was a sum score according to O'Brien calculated of five different questionnaires (BDI, SF-36, STAI, SCL 90R, F-SOZU-22). RESULTS The sum score for overall HRQOL did not show significant group differences at follow-up. Effects on HRQOL sub-dimensions within groups have been found. In the dimension of depression therapy group showed significant improvement from the first measurement to discharge from hospital (p < 0.001), 6 MFU (p = 0.004) and to 12 MFU (p = 0.013). Measures of anxiety showed significant improvement for the therapy group at discharge from hospital (p = 0.001). In the control group there was only a significant reduction in depression and anxiety from surgical ward to discharge (p = 0.013/p = 0.031). CONCLUSIONS Early onset cognitive therapy is not effective in improving overall HRQOL of severely injured patients but shows promising effects on depression and anxiety up to 12 months after trauma.
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Affiliation(s)
- Nicola Pirente
- Institute for Research in Operative Medicine (IFOM), Faculty of Medicine, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany
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Hepp U, Gamma A, Milos G, Eich D, Ajdacic-Gross V, Rössler W, Angst J, Schnyder U. Prevalence of exposure to potentially traumatic events and PTSD. The Zurich Cohort Study. Eur Arch Psychiatry Clin Neurosci 2006; 256:151-8. [PMID: 16267635 DOI: 10.1007/s00406-005-0621-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Accepted: 09/07/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the prevalence rate of exposure to potentially traumatic events (PTE) and posttraumatic stress disorder (PTSD) in a representative sample of the general population. METHOD A representative community-based cohort from the canton of Zurich, Switzerland was interviewed in 1993 and 1999 at the age of 34/35 and 40/41 years, respectively, by means of a semi-structured diagnostic interview. RESULTS The weighted lifetime prevalence of PTE in 1999 was 28%. Of the persons who reported exposure to PTE (criterion A), none met all the remaining criteria for PTSD according to the DSM-IV. Eleven persons (2 males and 9 females) met the criteria for subthreshold PTSD. This corresponds to a weighted 12-month prevalence for subthreshold PTSD of 1.30% (0.26 % for males; 2.21 % for females). In 1993, no participant met all criteria for PTSD according to the DSMIII- R. The weighted 12-month prevalence for subthreshold PTSD was 1.90 % (2.9 % for males; 0.9 % for females). CONCLUSION The prevalence of exposure to PTE in Switzerland was relatively low. No single case of full PTSD was found in the sample, and even for subthreshold PTSD the prevalence was very low. The relatively stable socio-economic and political climate in Switzerland may contribute to a sense of safeness, which may protect Swiss citizens to some extent from developing PTSD in the aftermath of traumatic experiences.
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Affiliation(s)
- Urs Hepp
- Department of Psychiatry, University Hospital, Culmannstrasse 8, 8091, Zurich, Switzerland.
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Rubin SS, Malkinson R, Witztum E. Trauma and bereavement: conceptual and clinical issues revolving around relationships. DEATH STUDIES 2003; 27:667-690. [PMID: 14535270 DOI: 10.1080/713842342] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The article re-examines trauma and bereavement and the category of loss considered to be traumatic bereavement. It is argued that the perspective of the relation to the deceased is an insufficiently acknowledged source of traumatic disruption following bereavement. The significance of the relational aspect in bereavement is present in the paradigm of the Two-Track Model of Bereavement (S. Rubin, 1981, 1999). The implications of this approach are examined in the case of a soldier exposed to trauma and death. The case is examined from a traditional trauma perspective stressing exposure to life threat and again from a perspective stressing the significance of the relationship to the deceased. An examination of the different intervention strategies and their outcome lends support to the importance of the relational aspects in this case of trauma and supports the use of the Two-Track Model of Bereavement. The location of trauma as basic to the experience of all bereavement for its impact on the reorganization vis a vis the representation of the loved one now deceased is considered as fundamental to the trauma of all bereavement. The additional contribution of bereavement occurring under conditions of life threat (traumatic situations) is an important feature potentially impacting the bereavement process, but it is not what makes bereavement traumatic per se. An additional source of trauma in bereavement, occurring when the previous representation or introject of the deceased is shattered, is considered for its status as an additional source of complication in the traumas of bereavement.
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Elklit A, Brink O. Acute Stress Disorder in physical assault victims visiting a Danish emergency ward. VIOLENCE AND VICTIMS 2003; 18:461-472. [PMID: 14582866 DOI: 10.1891/vivi.2003.18.4.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
UNLABELLED The purpose of this article is to assess the prevalence of Acute Stress Disorder (ASD) following violent assault in victims who come to the emergency ward, and compare the effects with degrees of injury. Two hundred and fourteen victims of violence completed a questionnaire 1 to 2 weeks after the assault. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist and the Crisis Support Scale. RESULTS Twenty-four percent met the full ASD diagnosis and 21% a subclinical ASD diagnosis. Childhood sexual and physical abuse and shock due to a traumatic event that happened to someone close increased the likelihood of ASD four to ten times. Feeling of security and ability to express feelings reduced the likelihood of ASD by one-quarter, while feeling let down by others and hopelessness increased the likelihood of ASD respectively 1.4 and 2.6 times.
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Affiliation(s)
- Ask Elklit
- Institute of Psychology, Aarhus University, Risskov, Denmark.
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Klein E, Caspi Y, Gil S. The relation between memory of the traumatic event and PTSD: evidence from studies of traumatic brain injury. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:28-33. [PMID: 12635561 DOI: 10.1177/070674370304800106] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This paper focuses on the relation between memory and posttraumatic stress disorder (PTSD). More specifically, it addresses the debate regarding the role of memory of the traumatic event in the development of PTSD. Traumatic brain injury (TBI) is used as a naturally occurring model for traumatic exposure that is often associated with memory impairment. METHOD We present a critical review of the literature on studies assessing the relation between TBI and PTSD, with a focus on memory of the traumatic event as a critical factor. We also discuss results from recent studies conducted by our group. RESULTS The literature review offers an inconclusive picture wherein a significant proportion of the studies indicate that PTSD and TBI are mutually exclusive, especially in individuals who exhibit lack of memory for the traumatic event. This finding supports the possibility that lack of memory may protect against the development of PTSD. However, some studies show that PTSD does occur in patients with head injury, suggesting that PTSD may develop in TBI survivors--even in those who cannot remember the traumatic event. Generally speaking, though, the overall balance of the findings (including our own findings) seems to support the possibility that, in subjects with TBI, impaired memory of the traumatic event is associated with reduced prevalence of PTSD. CONCLUSIONS The suggestion that amnesia regarding the traumatic event may protect against the development of PTSD has both theoretical and practical importance. This review focused on the case of traumatic brain injury as a model for impaired memory for the traumatic event. However, it still remains to be proven that the conclusions based on these findings are generalizable beyond the case of TBI. While some patients with posttraumatic amnesia do develop PTSD despite lack of memory for the traumatic event, the majority of those who lack memory for the event seem to be protected from developing the disorder. Nevertheless, based on this assumption, we suggest that pharmacologic disruption of newly acquired--or even old--traumatic memories, which has been shown to be possible in animals, might therapeutically benefit trauma survivors.
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Affiliation(s)
- Ehud Klein
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Department of Psychiatry, Rambam Medical Center, Haifa, Israel.
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Mason S, Wardrope J, Turpin G, Rowlands A. The psychological burden of injury: an 18 month prospective cohort study. Emerg Med J 2002; 19:400-4. [PMID: 12204984 PMCID: PMC1725976 DOI: 10.1136/emj.19.5.400] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the prevalence of post-trauma psychological problems among a cohort of male accident and emergency department patients admitted to hospital. To identify the changes in their psychological symptoms over an 18 month follow up period. METHODS A prospective cohort study of male accident and emergency department patients who were admitted for treatment of an injury. Baseline interview recorded demographic details and accident details. Standardised questionnaires measured baseline psychological state and personality type. Follow up at six weeks, six months, and 18 months after injury was by face to face interview or postal questionnaire and recorded progress since injury, and documented psychological status through the use of standardised questionnaires to detect psychiatric disorder and symptoms of post-traumatic stress disorder (PTSD). RESULTS 210 male patients were recruited into the study. Psychiatric disorder was identified in 47.6% of responders at six weeks, and 43.4% at six months after injury. This improved significantly at 18 months. PTSD symptoms were moderate in 25%-30% and severe in 5%-14% and did not change significantly over the study period. A significant relation was found between previous psychiatric history and psychological symptoms at 18 months after injury. No relation was identified between injury severity and psychological status after injury. CONCLUSION This study finds a high prevalence of psychological distress in male accident and emergency department patients after injury. Although some symptoms resolve over the follow up period, a proportion remain and may be related to previous psychiatric history. There was no relation identified between severity of injury and psychological morbidity.
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Affiliation(s)
- S Mason
- Department of Accident and Emergency Medicine, Northern General Hospital, Sheffield, UK.
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