目錄1.概述 21.1基本概念 21.2流行病學(xué)研究 21.3臨床體現(xiàn) 32.致病因素 32.1創(chuàng)傷事件 42.2易感因素 43.診療與評(píng)定 53.1診療 53.2評(píng)定 64.治療與防止 74.1心理治療 74.2藥品治療 84.3防止 8參考文獻(xiàn) 9

創(chuàng)傷后應(yīng)激障礙綜述社會(huì)沖突、自然災(zāi)害給人類造成了嚴(yán)重的生理和心理傷害。創(chuàng)傷后應(yīng)激障礙(posttraumaticstressdisorder,PTSD)已經(jīng)成為影響創(chuàng)傷救治整體水平的重要因素之一，嚴(yán)重干擾了人民生活和社會(huì)秩序。許多人產(chǎn)生了焦慮、抑郁、恐懼、重復(fù)不能忘記痛苦、出現(xiàn)回避行為等癥狀。這就使得對(duì)創(chuàng)傷后應(yīng)激障的研究越發(fā)顯得重要。1.概述1.1基本概念創(chuàng)傷后應(yīng)激障礙是一種由非同尋常的威脅或?yàn)?zāi)難性事件所引發(fā)的強(qiáng)烈的恐懼感、無(wú)助或厭惡等嚴(yán)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":"變態(tài)心理學(xué)與心理治療","publisher":"世界圖書出版公司","edition":"第三版","author":[{"family":"Nolen","given":"s"}],"issued":{"date-parts":[[""]]}}}],"schema":""}(Nolen,)，最少會(huì)持續(xù)一種月，其特性為創(chuàng)傷或?yàn)?zāi)難性事件后長(zhǎng)久存在的焦慮反映，重要癥狀為持續(xù)的警惕性增高癥狀群、重復(fù)發(fā)生的闖人性再體驗(yàn)癥狀群、反映性麻木癥狀群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":"心理障礙臨床手冊(cè)","edition":"第三版","author":[{"family":"David","given":"BarlowH."}]}}],"schema":""}(David,n.d.)。PTSD可引發(fā)明顯的職業(yè)、心理和社會(huì)功效殘疾，對(duì)個(gè)體的社會(huì)功效、家庭生活和身心健康造成長(zhǎng)久的破壞性影響，也給患者及其家庭乃至社。1.2流行病學(xué)研究據(jù)美國(guó)精神病協(xié)會(huì)(AmericanPsychiatryAsso-ciation，APA)統(tǒng)計(jì)，美國(guó)PTSD的人群總體患病率為1至14%，平均為8%，個(gè)體終身患病危險(xiǎn)性達(dá)3至58%，女性PTSD患者終身患病率高于男性，約是男性的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,)，因素在于傷害女性的暴力攻擊的發(fā)生更為普遍，如，性侵犯、身體傷害。普通人群中50%以上的人一生中最少有一次曾暴露于創(chuàng)傷事件，并不是全部的創(chuàng)傷幸存者都會(huì)發(fā)展為PTSD，普通人群中PTSD的患病率為7.8%。女性創(chuàng)傷暴露率為51.2%,PTSD的患病率為10.4%；男性創(chuàng)傷暴露率為60.7%,PTSD的患病率為5.0%。普通說來，不同的人群或個(gè)體，不同應(yīng)激事件所致P'TSD的患病危險(xiǎn)性亦不相似。調(diào)查發(fā)現(xiàn)，經(jīng)歷過滿足診療原則的創(chuàng)傷性事件的人，患有P'TSD的比率以下：強(qiáng)奸，32%；其它性攻擊，31%；軀體攻擊，39%；家人或朋友被殺，22%；其它犯罪的受害者，26%；非犯罪類的創(chuàng)傷(天災(zāi)人禍，事故，受傷等等)，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)。我國(guó)軍隊(duì)醫(yī)務(wù)工作者的流行病學(xué)調(diào)查，成果顯示軍人PTSD患病率為0,485%，其中，陸、海、空軍和學(xué)員的P'TSD患病率分別為0.484%,0.58%,0.84%和0.227%，特殊兵種或在執(zhí)行抗災(zāi)任務(wù)后的軍人P'TSD發(fā)病率明顯高于和平時(shí)期軍人P'TSD橫斷面調(diào)查的成果ADDINZOTERO_ITEMCSL_CITATION{"citationID":"e5nHpRCp","properties":{"formattedCitation":"{\\rtf(\\uc0\\u29579{},\\uc0\\u23828{},&\\uc0\\u38472{},1996)}","plainCitation":"(王,崔,&陳,1996)"},"citationItems":[{"id":299,"uris":[""],"uri":[""],"itemData":{"id":299,"type":"article-journal","title":"中國(guó)軍人心理創(chuàng)傷后應(yīng)激障礙的流行病學(xué)調(diào)查","container-title":"中華神經(jīng)科雜志","page":"69-72","issue":"29","author":[{"family":"王","given":"煥林"},{"family":"崔","given":"庶"},{"family":"陳","given":"繼軍"}],"issued":{"date-parts":[["1996"]]}}}],"schema":""}(王,崔,&陳,1996)。現(xiàn)在，我國(guó)由自然災(zāi)難和突發(fā)事故引發(fā)的心理創(chuàng)傷已引發(fā)心理學(xué)界重視。有些流行病學(xué)研究報(bào)告的數(shù)據(jù)，如張本等ADDINZOTERO_ITEMCSL_CITATION{"citationID":"FB1Pb6UE","properties":{"formattedCitation":"{\\rtf(\\uc0\\u24352{},\\uc0\\u29579{},&\\uc0\\u23385{},)}","plainCitation":"(張,王,&孫,)"},"citationItems":[{"id":300,"uris":[""],"uri":[""],"itemData":{"id":300,"type":"article-journal","title":"唐山大地震所致孤兒心理創(chuàng)傷后應(yīng)激障礙的調(diào)查","container-title":"中華精神科雜志","page":"111-114","issue":"33","author":[{"family":"張","given":"本"},{"family":"王","given":"學(xué)義"},{"family":"孫","given":"賀祥"}],"issued":{"date-parts":[[""]]}}}],"schema":""}(張,王,&孫,)對(duì)唐山大地震所致孤兒的P'TSD的調(diào)查顯示發(fā)病率為23%。徐唯等的研究表明，特大爆炸事故后P'TSD的發(fā)生率高達(dá)78.6%。1.3臨床體現(xiàn)PTSD的重要臨床體現(xiàn)可分為三組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","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dāng)及時(shí)根據(jù)事件類型，結(jié)合創(chuàng)傷后應(yīng)激障礙的危險(xiǎn)因素，對(duì)受害者的生理、心理、社會(huì)狀態(tài)以及應(yīng)對(duì)方式進(jìn)行全方面評(píng)定。早期的評(píng)定能夠緊急判斷創(chuàng)傷的可能性。評(píng)定的第一步是要擬定病史中的重要?jiǎng)?chuàng)傷性事件ADDINZOTERO_ITEMCSL_CITATION{"citationID":"1t2li6tq29","properties":{"formattedCitation":"(Weathers,Ruscio,&Keane,1999)","plainCitation":"(Weathers,Ruscio,&Keane,1999)"},"citationItems":[{"id":316,"uris":[""],"uri":[""],"itemData":{"id":316,"type":"article-journal","title":"PsychometricpropertiesofninescoringrulesfortheClinician-AdministeredPosttraumaticStressDisorderScale.","container-title":"PsychologicalAssessment","page":"124","volume":"11","issue":"2","source":"谷歌Scholar","author":[{"family":"Weathers","given":"FrankW."},{"family":"Ruscio","given":"AyeletMeron"},{"family":"Keane","given":"TerenceM."}],"issued":{"date-parts":[["1999"]]},"accessed":{"date-parts":[["",6,16]]}}}],"schema":""}(Weathers,Ruscio,&Keane,1999)，涉及事件本身以及事件發(fā)生的范疇和發(fā)生的頻率。評(píng)定創(chuàng)傷性事件可用的量表有:創(chuàng)傷應(yīng)激評(píng)定表(TraumaticStressSchedule)、創(chuàng)傷性事件問卷(TraumaticEventsQuestionnaire)、創(chuàng)傷后應(yīng)激診療量表(ThePosttraumaticStressDiagnos-ticScale)、戰(zhàn)爭(zhēng)暴露量表(CombatExposureScale)、潛在應(yīng)激事件訪談量表(ThePotentialStressfulEventsInterview),PTSD臨床監(jiān)測(cè)量表(TheDSM-WversionoftheClinician-AdministeredPTSDScale)。國(guó)內(nèi)學(xué)者在參考國(guó)外有關(guān)文獻(xiàn)和評(píng)定量表的基礎(chǔ)上，編制了創(chuàng)傷后應(yīng)激障礙自評(píng)量表(post-traumaticstressdisorderself-ratingscale,PTSD-SS)，經(jīng)檢查含有較好的信度和效度ADDINZOTERO_ITEMCSL_CITATION{"citationID":"1vpj6k4d19","properties":{"formattedCitation":"{\\rtf(\\uc0\\u21016{},\\uc0\\u39532{},&\\uc0\\u21016{},1998)}","plainCitation":"(劉,馬,&劉,1998)"},"citationItems":[{"id":317,"uris":[""],"uri":[""],"itemData":{"id":317,"type":"article-journal","title":"心理創(chuàng)傷后應(yīng)激障礙自評(píng)量表的編制和信度效度研究","container-title":"中國(guó)行為醫(yī)學(xué)科學(xué)","page":"93-96","volume":"2","issue":"7","author":[{"family":"劉","given":"賢臣"},{"family":"馬","given":"登岱"},{"family":"劉","given":"連啟"}],"issued":{"date-parts":[["1998"]]}}}],"schema":""}(劉,馬,&劉,1998)。4.治療與防止4.1心理治療心理治療是治療PTSD的重要辦法，比精神藥品治療更為有效。干預(yù)過程中根據(jù)正常化、協(xié)同化、個(gè)性化原則，干預(yù)的形式能夠多樣化，一對(duì)一的面談、電話咨詢、團(tuán)體輔導(dǎo)等方式可根據(jù)實(shí)際狀況靈活采用。常見的治療辦法涉及：應(yīng)激免疫訓(xùn)練(StressInoculationTrain-ing,SIT)、系統(tǒng)脫敏療法、延長(zhǎng)暴露(prolongexposure,PE)和視覺暴露治療、認(rèn)知加工治療(CognitiveProcessingTherapy,CPT)、眼動(dòng)脫敏和再加工(EyeMovementDesen-situationandReprocessing,EDMR)4.2藥品治療PTSD的藥品治療能緩和某些癥狀，減少患者的痛苦體驗(yàn)，普通作為心理治療的輔助方法，增加患者對(duì)心理治療的依從性。現(xiàn)在重要是使用選擇性5-經(jīng)色胺再攝取克制劑類抗抑郁藥品，它能夠明顯緩和抑郁、焦慮癥狀，改善睡眠質(zhì)量，減少回避癥狀。在我國(guó)還嘗試性應(yīng)用了中西藥結(jié)合治療創(chuàng)傷后應(yīng)激障礙，成果顯示起效快，副反映少，患者的依從性高。另外，軀體癥狀的改善能夠影響到個(gè)體情緒的變化，因此創(chuàng)傷事件發(fā)生后，應(yīng)針對(duì)個(gè)體的軀體癥狀及時(shí)予以藥品對(duì)癥治療。4.3防止早期干預(yù)的目的應(yīng)針對(duì)不同的個(gè)體、社區(qū)、文化需要和特性而制訂，精神衛(wèi)生人員應(yīng)被納人到重大事故或?yàn)?zāi)難解決小組中，使精神衛(wèi)生服務(wù)整合到災(zāi)難解決的計(jì)劃之中。對(duì)職業(yè)衛(wèi)生領(lǐng)域PTSD核心在于防止，重要方法在于加強(qiáng)安全教育和保護(hù)，防患于未然。完善職業(yè)環(huán)境的組織系統(tǒng)、社會(huì)支持系統(tǒng)、加強(qiáng)個(gè)體及群體心理素質(zhì)的培養(yǎng)，提高對(duì)創(chuàng)傷應(yīng)激事件的心理承受力也是其中核心環(huán)節(jié)。

參考文獻(xiàn)ADDINZOTERO_BIBL{"custom":[]}CSL_BIBLIOGRAPHYBaker,A.,&Shalhoub-Kevorkian,N.(1999).Effectsofpoliticalandmilitarytraumasonchildren:thePalestiniancase.ClinicalPsychologyReview,19(8),935–950.Breslau,N.().Theepidemiologyofposttraumaticstressdisorder:whatistheextentoftheproblem?JournalofClinicalPsychiatry.RetrievedfromButcher,J.