汶川地震后广元地区创伤后应激障碍调查

目的了解汶川地震9年后广元地区高二学生创伤后应激障碍(PTSD)阳性检出情况,为进一步分析震后PTSD持续存在的影响因素、对存在PTSD的学生进行心理干预提供参考。方法采用整群抽样方法,选取广元地区地震重灾区和一般灾区的1 492名高二学生为研究对象。采用创伤后应激障碍自评量表(PTSD-SS)和社会支持量表(PSSS)调查PTSD发生率和社会支持情况。结果广元地区高二学生PTSD阳性检出率为3.69%,男生和女生PTSD阳性检出率比较差异有统计学意义(2.24%vs. 5.82%,χ~2=12.47,P0.01),重灾区和一般灾区PTSD阳性检出率比较差异有统计学意义(4.89%vs. 2.84%,χ~2=4.27,P0.05);男生和女生PTSD-SS评分比较差异有统计学意义[(12.71±9.01)分vs.(14.02±8.52)分,t=-6.43,P0.01];PTSD阳性者和非阳性者PSSS评分比较差异有统计学意义[(57.52±7.53)分vs.(61.11±8.19)分,t=-5.36,P0.01]。结论汶川地震后9年,广元地区部分高二学生仍存在PTSD症状,创伤暴露程度、性别和社会支持可能与现患PTSD相关。     

创伤后应激障碍的叙事暴露治疗

创伤后应激障碍(PTSD)的治疗方法是心理卫生从业者非常关注的一个话题。目前已有大量的研究结果表明叙事暴露治疗(NET)是治疗PTSD的有效方法,特别适用于复杂创伤的治疗,然而在中国NET还未得到广泛应用。本文通过梳理NET的相关理论与研究现状,从理论背景、研究现况、操作过程与注意事项等方面进行介绍,讨论其优缺点并展望其在中国的发展。     

创伤后应激障碍的司法鉴定(附17例分析)

鉴于创伤后应激障碍（posttraumatic stress disorder,PTSD）引发的法律纠纷日趋突出。因此,本文试图通过对司法精神病鉴定中涉及到的PTSD案例作如下浅析,并提供同道参考。     

创伤后应激障碍评估量表综述

对创伤后应激障碍(Posttraumatic stress disorder,PTSD)进行及时、准确的评估和诊断,有助于对PTSD的早期识别和治疗。目前临床上PTSD的评估量表种类很多,主要包括筛查量表和诊断量表两类,不同量表的编制原理和使用方法不尽相同。本研究就常用评估量表进行总结。     

灾区籍大学生心理健康及应对方式研究

目的 了解汶川地震后某学院灾区籍大学生的应对方式和心理健康状况.方法 以四川某学院362例汶川地震灾区籍学生为研究对象,用应对方式问卷(CSQ)和症状自评量表(SCL-90)调查.结果 灾区籍大学男生、城市学生多采用成熟的应对方式,女生、农村学生多采用不成熟的应对方式;问题解决成为灾区籍大学生较常采用的应对方式.灾区籍大学生SCL-90得分与全国常模比较,除躯体化、敌对两个因子无显著差异外(P＞0.05),其余各因子得分差异显著(P＜0.01).灾区籍大学生SCL-90得分性别比较,人际关系敏感、敌对、抑郁差异显著(P＜0.01);生源比较,除敌对、偏执、恐怖外,其余备因子差异显著(P＜0.01).结论 灾区籍大学生存在一定的心理健康问题,其应对方式有性别、城乡差异.在以后的心理健康教育中,应对女性、农村学生特别关注.     

创伤后应激障碍

本综述了创伤后应激障碍的病因学、临床特征及治疗方面的新进展。     

创伤后应激障碍的睡眠障碍

尽管睡眠障碍在精神疾病中非常常见，但他常常被当作精神疾病的二级症状，认为对其主要精神疾病的治疗才是缓解睡眠苦恼的最可行办法。事实上，比如创伤后应激障碍(PTSD)的噩梦并不随总症状评分的下降而减少，有时可持续很长时间，而采用针对睡眠紊乱的治疗方案后，超过50％患者的创伤后应激症状可得到有效缓解。现论述PTSD对睡眠的影响，并讨论睡眠紊乱的治疗问题。     

论创伤后应激障碍的司法精神病学鉴定

目的探讨创伤后应激障碍的本质特征及司法精神病学鉴定实践中争议较大的问题。方法对PTSD诊断标准和流行病学、应激源、发病机制及共病特征进行研究,对PTSD鉴定中存在的诊断扩大化倾向、人格特征关系、心理创伤界定、创伤性事件与精神障碍的关系、精神损伤程度的评定以及鉴别诊断进行分析论证。结果应激源的强烈程度并非导致PTSD发生的唯一因素,患者在创伤性事件前的人格特征、幼年经历、生活处境、遗传易感性以及事件后的社会支持系统启动程度等均可成为PTSD潜在致病因素。结论PTSD司法精神病学鉴定应采取多元化诊查措施做出评定,谨慎处置伪现象干扰。     

执行功能的异常与创伤后应激障碍之间的关联

正创伤后应激障碍(Post-traumatic Stress Disorder,PTSD)是对异乎寻常的威胁性或灾难性应激事件或情境延迟的和/或延长的反应(世界卫生组织,1992)。1980年DSM-Ⅲ首次确立创伤后应激障碍诊断标准后,对PTSD患者认知特点的研究主要集中于记忆方面。Kanagaratnam等[1]提出,个体将对环境的感知整合为一个整体的能力,是其成功地认     

延时暴露疗法治疗创伤后应激障碍临床研究

目的：了解延时暴露疗法对创伤后应激障碍（PTSD）患者症状的疗效。方法：使用创伤后应激障碍自评量表（PTSD-SS）、抑郁自评量表（SDS）、焦虑自评量表（SAS）对高中生进行测评,采用延时暴露疗法对21名PTSD患者进行了治疗。结果：地震后1年高中生PTSD患病率为6.65%,女性高于男性,延时暴露治疗后症状明显改善。结论：延时暴露疗法对地震后高中生PTSD治疗有效,在以后的心理干预中应注意关注PTSD患者的恐惧和回避症状。     

以Microsoft Access 2000系统开发构建汶川地震颌面部创伤伤员数据库的特点*◆

采用华西口腔医院5.12地震口腔颌面部创伤调查表对2008-05-12/06-30在汶川地震中以及随后余震中受伤的共419例颌面部创伤伤员的临床资料进行收集,并利用Microsoft Access 2000软件建立华西口腔医学院颌面部创伤伤员数据库。利用该软件在较短时间内完成了419例伤员的临床资料数据库的建立,并进行了伤情特点分析,数据库运行良好,有较强的数据处理能力。结果提示,利用Microsoft Access 2000建立颌面部创伤数据库简单、实用,有利于病案的信息化管理和临床诊疗、教学和科研。     

汶川地震后绵竹市高中学生心理健康状况及其相关因素研究

目的探讨地震后灾区高中学生心理健康、社会支持状况及相关因素。方法对随机抽样选择的816例绵竹市高中学生分别采用一般情况调查表、事件影响量表修订版（IES—R）、社会支持评定量表（SSRS）、领悟社会支持量表（PSSS）及症状自评量表（SCL-90）进行测量。结果（1）绵竹市高中学生PTSD发生率为13．11％;（2）绵竹市高中学生SCL-90各项指标分值（躯体化及人际关系敏感除外）远远大于常模组（P〈0．05）;（3）绵竹市高中学生SSRS各项指标分值低于常模组（P〈0．05）,而PSSS各项指标中,领悟社会支持总分、家庭支持、其他支持分值高于常模组（P〈0．05）;（4）绵竹市高中学生IES—R分值与地震当时的主观感受（r=0．36,P〈0．05）、亲人的受伤情况（r=0．21,P〈0．05）、朋友及同学的受伤情况（r=0．18．P〈0．05）、家庭财产损失情况（r=0．11,P〈0.05）呈正相关;（5）IES—R分值与SCL-90各项指标（躯体化、人际关系敏感除外）均成正相关（P〈0．05）。（6）IES—R分值与PSSS中领悟社会支持总分（r=-0．09,P〈0．05）、朋友支持（r=-0．09,P〈0．05）、其他支持（r=-0．09,P〈0．05）呈负相关。结论与正常人群比较,绵竹市高中学生地震后的心理健康水取较差;他们较正常人群对社会支持的领悟更敏感;有效的社会支持及对社会支持的感受可降低PTSD发生率。     

The effect of trauma-focused therapy on the altered T cell distribution in individuals with PTSD: Evidence from a randomized controlled trial

Posttraumatic stress disorder (PTSD) is associated with a reduced ratio of naïve cytotoxic T lymphocytes, an increased ratio of memory cytotoxic T lymphocytes, and a reduced proportion of FoxP3⁺ regulatory T lymphocytes. This study investigated whether these immunological alterations are reversible through an evidence-based psychotherapeutic treatment. Therefore, 34 individuals with PTSD were randomly assigned to either a treatment condition of 12 sessions narrative exposure therapy (NET) or a waitlist control (WLC) group. PTSD symptoms were significantly reduced in the NET group, but not in the WLC group, four months post-therapy (effect size: Hedges' g = −1.61). One year after therapy, PTSD symptoms were improved even further in the NET group compared to baseline (Hedges' g = −1.96). This symptom improvement was mirrored in an increase in the originally reduced proportion of regulatory T cells (T_regs) in the NET group at the one-year follow-up, when comparing subgroups matched for baseline T_reg numbers. However, no changes were found for the initially reduced proportion of CD45RA⁺CCR7⁺ naïve T lymphocytes. In conclusion, NET was effective in reducing trauma-related PTSD symptoms and had a positive effect on the proportion of T_regs cells, thus demonstrating an effect of psychotherapy on an immunological level. Yet, the shift in the proportion of naïve and memory T lymphocytes in individuals with PTSD, discussed in the literature as a correlate of premature immunosenescence, was not reversible and thus might render these patients permanently more susceptible to infectious diseases.     

The utility of college student samples in research on trauma and posttraumatic stress disorder: A critical review

There is a widespread notion of the ‘college sophomore problem’ in social science research that posits that college student samples are samples of convenience with little generalizability to the general population. To address this concern, we conducted a critical review of the literature on college student samples in trauma research. Specifically, we reviewed how college student samples differ from non-college samples in four key areas of trauma research: (1) exposure rates to potentially traumatic events (PTEs), (2) prevalence of posttraumatic stress disorder (PTSD) symptoms, (3) factor structure of PTSD symptoms, and (4) PTSD’s relation with common markers, correlates, and consequences. Lastly, we discussed the value and advantages of using college student samples in trauma research. Results of the critical review indicated similar trends of trauma-related findings (Points 1–4) between college student samples and both U.S. nationally collected and treatment-seeking samples; specifically, we identified a comparable lifetime PTE exposure rate, comparable rates of PTSD, a comparable factor structure of PTSD symptoms, and a comparable pattern of associations between PTSD symptoms and post-trauma markers/correlates/consequences. Although trauma-exposed college student samples are biased in some key areas, they may be no more biased than other commonly used trauma samples (e.g. epidemiological, treatment-seeking). Results of this critical review highlight the need to re-examine potentially unfounded biases on the part of the trauma research community, as well as the need to consider advantages of using college student samples in trauma research.     

三本院校大学生认知需求与适应性的关系研究

目的 对三本大学生认知需求和适应性的测评分析,探讨三本大学生的认知需求和适应性的基本特点,适应性与认知需求的关系以及认知需求对适应性的影响模式.方法 采用大学生认知需求量表、大学生适应性量表对765例三本院校大学生施测.结果 (1)三本院校男生的认知需求高于女生,城市学生的认知需求显著低于农村学生,家庭贫困学生的认知需求高于家庭富裕和一般的学生;(2)认知需求、性别、生源地、家庭富裕程度都是影响适应性的因素,并随着年级表现出不同的特点;(3)三本院校大学生的认知需求、适应性相关显著.家庭经济状况、年级、性别、生源地均能显著预测适应性.结论 认知需求能够显著预测适应性;性别和生源地是认知需求与适应性的调节变量.     

The effects of restricted group sandplay therapy on interpersonal issues of college students in China

This study explored the outcomes of restricted group sandplay therapy (RGST) on college students in China with interpersonal difficulties and self image issues. The study involved nine students at a university in Beijing identified with social distress and avoidance issues who participated in an eight session group therapy intervention using the RGST approach. Participant outcomes were measured using both objective and subjective measures. Objective measure involved the Social Avoidance and Distress Scale (SAD) at pretest and posttest to measure the social avoidance and distress participants felt before and after the group. The subjective means involved examining the sandtray creations of the group each session to observe overall changes in the group's attitudes and reactions toward each other; and by evaluating participants’ self image as reflected by their choice of sandtray miniatures to represent themselves at pretest and posttest.. The results suggested noticeable improvements in both participants’ SAD scores and self-image representations The group process also showed marked improvement in the amount of social awareness and coordination experienced by group members through the RGST intervention. Although the results must be regarded as tentative due to a low sample size and lack of regression statistical analyses, the group appeared to show promising findings for the use of the RGST in future social skills groups.     

藏族大学生情绪调节与自我控制能力的关系

目的探讨藏族大学生情绪调节与自我控制能力的关系。方法采用自我控制能力问卷和情绪调节量表对457名藏族大学生进行调查。结果（1）藏族大学生自我控制能力的情绪自控维度与情绪调节的重新评价和表达抑制两个雏度之间存在显著正相关;自我控制总分与重新评价维度存在显著正相关;（2）情绪调节的重新评价维度在自我控制能力的情绪自控维度上、行为自控维度上和自我控制能力总分上存在显著差异;（3）情绪调节的表达抑制与情绪自控评分存在显著相关。结论藏族大学生的情绪调节与自我控制能力高度相关。     

Exploratory factor analysis of two measures of posttraumatic stress disorder (PTSD) symptoms in a non-clinical sample of college students

This study investigated the psychometric structure of two widely utilized measures of posttraumatic symptoms in a primarily Caucasian non-clinical sample. Given the prevalence of trauma exposure in non-referred samples, measurement of resulting symptoms is a critical issue. Exploratory factor analysis was utilized to assess and compare the factor structure of the Impact of Event Scale [IES; Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: a measure of subjective stress. Psychosomatic Medicine, 41, 209-218] and the Mississippi Scale for Posttraumatic Stress Disorder, Civilian version [MIS-Civ; Vreven, D. L., Gudanowski, D. M., King, L. A., & King, D. W. (1995). The Civilian Version of the Mississippi PTSD Scale-a psychometric evaluation. Journal of Traumatic Stress, 8, 91-109] in a sample of college students reporting exposure to potentially traumatic events. The psychometric structure of the IES was largely consistent with the two-factor structure widely reported in the literature, while the structure of the MIS-Civ varied considerably in this sample. Notably, non-clinical samples tended to report fewer social and occupational dysfunction than clinical samples predominantly utilized in PTSD research. Implications for use of these instruments in screening samples are discussed.