_guidelines forposttraumatic stress disorder临床指南后创伤后应激障碍课件

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1、ClinicalGuidelinesforPost-traumaticStressDisorderMyleaCharvat–PTSDSpecialistWarRelatedIllnessandInjuryStudyCenterVAPaloAltoHealthCareSystemmylea.charvat@va.govOutlineEpidemiologyandCriteriaRiskPathwaystoPTSDGender&CulturalIssuesinPTSDDoDGuidelines:Diagnosis&Assess

2、mentPharmacologyPsychotherapiesResourcesDSM-IVCriteriaPersonExperiencesTraumaticEventPersonExperiencesFear,HelplessnessorHorrorThepersonexperiencesacombinationofthefollowingSxwhicharestillpresent>4weeksfollowingtheTE,lastmorethanonemonthandcausesignificantdistressRe

3、-experiencing>1IntrusivethoughtsormemoriesTraumarelateddreamsActing/feelingasthoughthetraumawerereoccurringEmotionaldistressinresponsetotriggersPhysicalSxinresponsetotriggersAvoidance>3EffortstoavoidtraumarelatedthoughtsorfeelingsAvoidanceofpeople,placesoractivities

4、thattriggerremindersoftraumaMemorylossforallorpartsofthetraumaLossofinterestinactivitiesFeelingsofestrangementfromothersExpectationofforeshortenedfutureHyperarousal>2DifficultywithsleepIrritabilityandangerAttentionandConcentrationproblemsHypervigilenceExaggeratedsta

5、rtlereactionEpidemiologyofTraumaExposureOnlyNationalSample(Kessleretal.,1995)oftraumaexposure61%ofmenreportedDSM-IIITE51%ofwomenreportedDSM-IIITEVeteranData(USDVA,2003)–surveyed20,000VeteransinUSCombatexposure(41%men/12%women)36%exposuretodead/dying/woundedNoMSTdata

6、werecollectedWWIIVeteransreporteda54%exposureratetocombatcomparedto19%forKoreaEpidemiologyofPTSDRatesConsistentsinceDSM-III-REstimatesrangebetween6%and12%ingeneralpopulationKessleretal.,1995-NationalsurveyfoundPTSDratesof:20%forwomen8%formenEpidemiologyofPTSDinVeter

7、ansStudyof2,300VietnamEraVeterans31%ofmenmetPTSDcriteria27%ofwomenmetPTSDcriteriaPrevalencehigherwithArmyservice(comparedtootherbranches)>12monthsserviceEnteringservicebetweenageof17and19(Kulkaetal.,1990;Schlengeretal.,1992)EstimatesofTEExposure&PTSDprevalenceamongO

8、EF/OIFVeteransRiskPathwaystoPTSDTEsthatinvolveinjurytoselforothersTEsthataremore“malicious”and“grotesque”DissociationatthetimeoftheTELower