创伤后应激障碍综述

目录1.概述 21.1基本概念 21.2流行病学研究 21.3临床体现 32.致病因素 32.1创伤事件 42.2易感因素 43.诊疗与评定 53.1诊疗 53.2评定 64.治疗与防止 74.1心理治疗 74.2药品治疗 84.3防止 8参考文献 9

创伤后应激障碍综述社会冲突、自然灾害给人类造成了严重的生理和心理伤害。创伤后应激障碍(posttraumaticstressdisorder,PTSD)已经成为影响创伤救治整体水平的重要因素之一，严重干扰了人民生活和社会秩序。许多人产生了焦虑、抑郁、恐惧、重复不能忘记痛苦、出现回避行为等症状。这就使得对创伤后应激障的研究越发显得重要。1.概述1.1基本概念创伤后应激障碍是一种由非同寻常的威胁或灾难性事件所引发的强烈的恐惧感、无助或厌恶等严重的心理反映ADDINZOTERO_ITEMCSL_CITATION{"citationID":"q4BoNLVo","properties":{"formattedCitation":"(Nolen,)","plainCitation":"(Nolen,)"},"citationItems":[{"id":295,"uris":[""],"uri":[""],"itemData":{"id":295,"type":"book","title":"变态心理学与心理治疗","publisher":"世界图书出版公司","edition":"第三版","author":[{"family":"Nolen","given":"s"}],"issued":{"date-parts":[[""]]}}}],"schema":""}(Nolen,)，最少会持续一种月，其特性为创伤或灾难性事件后长久存在的焦虑反映，重要症状为持续的警惕性增高症状群、重复发生的闯人性再体验症状群、反映性麻木症状群ADDINZOTERO_ITEMCSL_CITATION{"citationID":"54ckeaxe","properties":{"formattedCitation":"(David,n.d.)","plainCitation":"(David,n.d.)"},"citationItems":[{"id":296,"uris":[""],"uri":[""],"itemData":{"id":296,"type":"book","title":"心理障碍临床手册","edition":"第三版","author":[{"family":"David","given":"BarlowH."}]}}],"schema":""}(David,n.d.)。PTSD可引发明显的职业、心理和社会功效残疾，对个体的社会功效、家庭生活和身心健康造成长久的破坏性影响，也给患者及其家庭乃至社。1.2流行病学研究据美国精神病协会(AmericanPsychiatryAsso-ciation，APA)统计，美国PTSD的人群总体患病率为1至14%，平均为8%，个体终身患病危险性达3至58%，女性PTSD患者终身患病率高于男性，约是男性的2倍ADDINZOTERO_ITEMCSL_CITATION{"citationID":"qmdoqqmr7","properties":{"formattedCitation":"(Breslau,)","plainCitation":"(Breslau,)"},"citationItems":[{"id":297,"uris":[""],"uri":[""],"itemData":{"id":297,"type":"article-journal","title":"Theepidemiologyofposttraumaticstressdisorder:whatistheextentoftheproblem?","container-title":"JournalofClinicalPsychiatry","source":"谷歌Scholar","URL":"","shortTitle":"Theepidemiologyofposttraumaticstressdisorder","author":[{"family":"Breslau","given":"Naomi"}],"issued":{"date-parts":[[""]]},"accessed":{"date-parts":[["",6,12]]}}}],"schema":""}(Breslau,)，因素在于伤害女性的暴力攻击的发生更为普遍，如，性侵犯、身体伤害。普通人群中50%以上的人一生中最少有一次曾暴露于创伤事件，并不是全部的创伤幸存者都会发展为PTSD，普通人群中PTSD的患病率为7.8%。女性创伤暴露率为51.2%,PTSD的患病率为10.4%；男性创伤暴露率为60.7%,PTSD的患病率为5.0%。普通说来，不同的人群或个体，不同应激事件所致P'TSD的患病危险性亦不相似。调查发现，经历过满足诊疗原则的创伤性事件的人，患有P'TSD的比率以下：强奸，32%；其它性攻击，31%；躯体攻击，39%；家人或朋友被杀，22%；其它犯罪的受害者，26%；非犯罪类的创伤(天灾人祸，事故，受伤等等)，9%ADDINZOTERO_ITEMCSL_CITATION{"citationID":"CFj8GR0G","properties":{"formattedCitation":"(Gilliland&James,1998)","plainCitation":"(Gilliland&James,1998)"},"citationItems":[{"id":298,"uris":[""],"uri":[""],"itemData":{"id":298,"type":"book","title":"Theoriesandstrategiesincounselingandpsychotherapy","publisher":"Allyn&Bacon","source":"谷歌Scholar","author":[{"family":"Gilliland","given":"BurlE."},{"family":"James","given":"RichardK."}],"issued":{"date-parts":[["1998"]]}}}],"schema":""}(Gilliland&James,1998)。我国军队医务工作者的流行病学调查，成果显示军人PTSD患病率为0,485%，其中，陆、海、空军和学员的P'TSD患病率分别为0.484%,0.58%,0.84%和0.227%，特殊兵种或在执行抗灾任务后的军人P'TSD发病率明显高于和平时期军人P'TSD横断面调查的成果ADDINZOTERO_ITEMCSL_CITATION{"citationID":"e5nHpRCp","properties":{"formattedCitation":"{\\rtf(\\uc0\\u29579{},\\uc0\\u23828{},&\\uc0\\u38472{},1996)}","plainCitation":"(王,崔,&陈,1996)"},"citationItems":[{"id":299,"uris":[""],"uri":[""],"itemData":{"id":299,"type":"article-journal","title":"中国军人心理创伤后应激障碍的流行病学调查","container-title":"中华神经科杂志","page":"69-72","issue":"29","author":[{"family":"王","given":"焕林"},{"family":"崔","given":"庶"},{"family":"陈","given":"继军"}],"issued":{"date-parts":[["1996"]]}}}],"schema":""}(王,崔,&陈,1996)。现在，我国由自然灾难和突发事故引发的心理创伤已引发心理学界重视。有些流行病学研究报告的数据，如张本等ADDINZOTERO_ITEMCSL_CITATION{"citationID":"FB1Pb6UE","properties":{"formattedCitation":"{\\rtf(\\uc0\\u24352{},\\uc0\\u29579{},&\\uc0\\u23385{},)}","plainCitation":"(张,王,&孙,)"},"citationItems":[{"id":300,"uris":[""],"uri":[""],"itemData":{"id":300,"type":"article-journal","title":"唐山大地震所致孤儿心理创伤后应激障碍的调查","container-title":"中华精神科杂志","page":"111-114","issue":"33","author":[{"family":"张","given":"本"},{"family":"王","given":"学义"},{"family":"孙","given":"贺祥"}],"issued":{"date-parts":[[""]]}}}],"schema":""}(张,王,&孙,)对唐山大地震所致孤儿的P'TSD的调查显示发病率为23%。徐唯等的研究表明，特大爆炸事故后P'TSD的发生率高达78.6%。1.3临床体现PTSD的重要临床体现可分为三组ADDINZOTERO_ITEMCSL_CITATION{"citationID":"xDAzudfY","properties":{"formattedCitation":"(Nietzel&Wakefield,1996)","plainCitation":"(Nietzel&Wakefield,1996)"},"citationItems":[{"id":301,"uris":[""],"uri":[""],"itemData":{"id":301,"type":"article-journal","title":"AmericanPsychiatricAssociationDiagnosticandStatisticalManualofMentalDisorders","container-title":"CONTEMPORARYPSYCHOLOGY","page":"642–651","volume":"41","source":"谷歌Scholar","author":[{"family":"Nietzel","given":"M.T."},{"family":"Wakefield","given":"J.C."}],"issued":{"date-parts":[["1996"]]}}}],"schema":""}(Nietzel&Wakefield,1996)：第一组为重复体验创伤性事件，如，侵人性的回想和重复出现的恶梦；第二组为保护性的反映，如，回避与创伤有关的刺激和情感麻木；第三组为高度警惕的症状，如，惊跳反映和过分警惕。2.致病因素2.1创伤事件PTSD最初来源于战争创伤后，其因素普通为异乎寻常的战斗事件。后来战争创伤的概念扩展到其它事件，如，大的灾难、躯体的攻击、暴力性侵害等。成为病因的压力能够是来自躯体的或情感的，能够是单独的或重复的，范畴能够从自然灾害、事故到刑事暴力、虐待、战争，这种压力既能够是直接经历，如，被打伤，也能够是间接经历ADDINZOTERO_ITEMCSL_CITATION{"citationID":"YHSpG8Jw","properties":{"formattedCitation":"(Nolen,)","plainCitation":"(Nolen,)"},"citationItems":[{"id":295,"uris":[""],"uri":[""],"itemData":{"id":295,"type":"book","title":"变态心理学与心理治疗","publisher":"世界图书出版公司"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参考文献ADDINZOTERO_BIBL{"custom":[]}CSL_BIBLIOGRAPHYBaker,A.,&Shalhoub-Kevorkian,N.(1999).Effectsofpoliticalandmilitarytraumasonchildren:thePalestiniancase.ClinicalPsychologyReview,19(8),935–950.Breslau,N.().Theepidemiologyofposttraumaticstressdisorder:whatistheextentoftheproblem?JournalofClinicalPsychiatry.RetrievedfromButcher,J.