交通事故存活者有比較高的精神異常比率


  May 9, 2008(華盛頓特區) — 一篇新的研究顯示,交通事故的住院存活者有比較高的急性壓力異常、創傷後壓力異常(PTSD)、憂鬱和焦慮症狀的比率,這可能會影響他們的恢復能力。
  
  第一作者、健康科學軍事大學的Quinn Biggs博士針對100名在南芝加哥創傷中心的這類罹難者,在事故發生之後2天到3週進行心智健康訪問。
  
  Biggs博士表示,這100名中22人有急性壓力異常;雖然沒有足夠時間診斷PTSD、憂鬱或焦慮,他發現27人有PTSD 症狀、26人有憂鬱症狀、20人有焦慮症狀。
  
  Biggs博士向 Medscape Psychiatry表示,創傷團隊、創傷中心、第一線急救者應瞭解病患有較高可能性出現心理症狀。
  
  【嚴重的碰撞事故】
  為了進行訪談,作者使用戴氏創傷量表(DTS)測量創傷壓力;使用流行病學研究中心之憂鬱量表(CES-D)測量憂鬱;使用貝克焦慮量表(BAI)測量焦慮;使用新的精神疾病診斷與統計手冊第4版(DSM-IV)診斷急性壓力異常的相關問題。
  
  作者寫道,許多變項與精神病理學有關,包括精神問題治療史,酒精/藥物使用,事故後對死亡的恐懼,過去一年的碰撞次數,一生中的壓力事件次數,對於控制會引起碰撞的事件,以及碰撞相關罪惡感有較大的認知。
  
  四分之三的病患是因為汽車碰撞,其他的是機車、行人和其他事故。
  
  Biggs博士指出,他們認為這些碰撞相當嚴重;60%發生翻覆,約有三分之一被殘骸陷住或壓住,有些被壓住至少45分鐘。
  
  他們遭受的創傷也很嚴重,100人之中有90人認為他們的傷害是中等以上、嚴重甚至致命的;超過半數失去意識,23人目睹一名認識的人受重傷,1人目睹認識的人死亡,其餘14 人目睹不認識的人受重傷,3人目睹不認識的人死亡,40人認為自己可能會死。
  
  作者指出這關聯沒有因果關係,事實上,在事故之前有許多人就已經有一些問題。
  
  Biggs博士指出,一如預期,有些人是嚴重酗酒者,過去每週飲酒10-15杯的人佔5%,另外有5%的人每週飲酒23杯以上。
  
  Biggs博士表示,約有半數、49%的人指出在他們一生中曾有過嚴重憂鬱;他指出,嚴重憂鬱或者治療憂鬱的報告與憂鬱症狀有關。
  
  此外,在一生中有相當壓力事件或者在過去一年有其他碰撞事故的病患也比較可能有PTSD 症狀,這些症狀也和Biggs博士在研究中發現的因素有關,那就是:如果你認為你會死,你發生創傷後壓力症狀的機會也越高。
  
  Biggs博士表示,研究中有一些特殊之處,就是研究病患的感覺控制,大多數的人認為他們對引起碰撞的事件難以控制或無法控制 ,但是這些人也比較可能有憂鬱症狀和罪惡感。
  
  此外,他指出,如果病患認為自己對恢復過程比較有控制能力,就比較不會有憂鬱症狀;他表示,這有其道理,因為對醫師和護士有信心的病患會感覺比較好。
  
  作者強調,及早辨識個人的精神病理與創傷特徵對發展早期介入是重要的。
  
  【早期篩選與及早介入】
  作者表示,研究影響了對存活者的早期篩選和訓練健康照護者的精神病理辨識與早期介入;不過,Biggs博士表示,依照他的經驗,健康中心不會要求心智健康專業人士參與創傷案例,除非他們確定病患真的有此問題時。
  
  他也指出,有些碰撞罹難者會經歷碰撞後「蜜月」期, 他們會感激活著且認為碰撞後讓他們的生命變好;但是當繼續面對適應上的挑戰時,這些也會消失,他表示,有些人的症狀每況愈下,有些人會變好;健康照護提供者應仔細注意。
  
  Biggs博士表示,這意味著照護者須與病患談論有關安全的話題。
  
  美國精神科學會第161屆年會:摘要 NR6-114。發表於2008年5月7日。

Collision Survivors Show High<

By Kathryn Foxhall
Medscape Medical News

May 9, 2008 (Washington, DC) — Hospitalized survivors of transportation collisions have high rates of acute stress disorder, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms that may affect their ability to recover, a new study shows.

The researchers, with first author Quinn Biggs, PhD, a research scientist with the Uniformed Services University of the Health Sciences, in Bethesda, Maryland, undertook mental health interviews in 100 such victims while they were still in a trauma center in south Chicago, 2 days to 3 weeks after their collision.

Twenty-two of the 100 had acute distress disorder, Dr. Biggs said. Although there had not been enough time since the incident to diagnose PTSD, depression, or anxiety, he found symptoms of PTSD in 27 people, depression symptoms in 26, and anxiety disorder symptoms in 20.

Trauma teams, trauma centers, and first responders "should be aware that patients are going to be having a high degree of psychological symptoms," Dr. Biggs told Medscape Psychiatry.

Serious Collisions

For the interviews, the authors used the Davidson Trauma Scale (DTS) for traumatic stress; the Center for Epidemiologic Studies Depression Scale (CES-D) for depression; the Beck Anxiety Inventory (BAI) for anxiety; and the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) diagnosis-related questions for acute stress disorder.

"Several variables were correlated to psychopathology, including history of treatment for psychological problems, alcohol/drug use, postcollision fear of dying, prior number of collisions in the past year, prior number of stressful events in the lifetime, greater perception of control of events that caused the collision, and collision-related guilt," the authors write.

Three-quarters of the patients had been in auto collisions, and the others had been in motorcycle, pedestrian, and other incidents.

Dr. Biggs noted, "The collisions that they had been through were quite serious. Sixteen percent had a rollover, and about a third of them were trapped or pinned in the wreckage. Some of them were trapped for over 45 minutes."

The trauma they sustained was also serious. Ninety of the 100 rated their injuries as moderate, severe, or life-threatening. Over half had lost consciousness, 23 had witnessed the serious injury of a known person, and 1 had witnessed the death of a known person. Another 14 had witnessed serious injury of an unknown person, and 3 had witnessed the death of an unknown person. Forty had thoughts that they themselves might die.

The authors pointed out that the correlations cannot indicate the cause and effect, and, in fact, there were indications many of these people had problems before the accident.

As one might expect, said Dr. Biggs, some were probably serious drinkers: "Five percent drank between 10 and 15 drinks per week in the past, and another 5% drank 23 or more drinks per week."

"About half, 49%, reported that they had had serious depression at least sometime in their life," said Dr. Biggs. The reports of serious depression or being treated for depression correlated well with the symptoms of depression on the symptom inventories, he noted.

In addition, the patients with more extremely stressful events in their lifetime or other collisions in the past year were more likely to have PTSD symptoms. Those symptoms also correlated with a factor Dr. Biggs said research has repeatedly found: "If you think you are going to die, you are more likely to have posttraumatic stress symptoms."

Something unique in the study, said Dr. Biggs, was its research on patients' feeling of control. Most people felt they had little or no control over the events that caused the collision, but those who did were more likely to have depressive symptoms and guilt.

Beyond that, he pointed out, "If the patient rated others as having a high degree of control over their recovery process, they were less likely to have depression symptoms." That makes sense, he said, because a patient who is confident in the doctors and nurses will probably feel better.

The authors stressed that "early identification of the personal and injury characteristics associated with psychopathology is vital to development of early interventions."

Early Screening and Early Intervention

The study has implications for early screening of survivors and early intervention and training of healthcare providers to identify psychopathology, said the authors. However, Dr. Biggs said, in his experience, health centers don't call in a mental health professional in trauma cases unless they can actually see someone has a problem.

He also pointed out that some collision victims go through a postcollision "honeymoon" period in which they are glad to be alive and they may feel the collision has changed their lives for the better. But people "this broken up" will continue to face adaptation challenges, he said: "So some people's symptoms are going to go down. I think some will probably go up. And I think that healthcare providers should watch for that."

There may also be points in the process for providers to talk to patients about safety, Dr. Biggs said.

American Psychiatric Association 161st Annual Meeting: Abstract NR6-114. Presented May 7, 2008.

    
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