创伤后应激障碍合并酒精使用障碍的访谈与治疗

Interview and treatment of post-traumatic stress disorder with alcohol use disorder

本文目的是通过报道病例诊疗全过程,呈现创伤后应激障碍(PTSD)合并酒精使用障碍的临床诊疗思路及治疗方案。咨客,男性,55岁。12岁时目睹母亲自杀的全过程,随后出现恐惧、孤独、失眠、回避谈论创伤相关话题、反复出现与创伤相关的梦境、易激惹、疼痛及酗酒等一系列情绪、认知、躯体及行为改变,并持续至今。社会功能明显受损,近1年和妻子离婚后症状加重而前来咨询。经过本次咨询,被诊断为PTSD合并酒精使用障碍。建议采用生物-心理-社会的综合干预方法,鼓励咨客进行规律运动,使用选择性5-羟色胺和去甲肾上腺素再摄取抑制剂(SNRI)及第二代抗精神病药物改善情绪、缓解疼痛;心理治疗方面,推荐延迟暴露疗法和认知调整;社会资源方面,在症状缓解后,鼓励咨客积极寻找工作,创造挽回其前妻的可能性。

The purpose of this article is to report the whole process of clinical diagnosis and treatment of post-traumatic stress disorder (PTSD) combined with alcohol use disorder. The patient, a 55-year-old male, witnessed the whole process of his mother's suicide at the age of 12. Since then, the patient has suffered a series of emotional, cognitive, physical and behavioral changes, such as fear, loneliness, insomnia, avoidance of trauma-related topics, repeated trauma-related dreams, irritability, pain and alcoholism , and those phenomena have not been alleviated so far. The impaired social functions were aggravated because of the divorce one year ago, so the patient came to consult. After this consultation, the patient was diagnosed with PTSD combined with alcohol use disorder. The biological-psychological-social intervention model was recommended, including regular exercises, oral administration of selective serotonin norepinephrine reuptake inhibitor (SNRI) and second-generation antipsychotics. In terms of psychotherapy, prolonged exposure therapy and cognitive adjustment were recommended. As for social intervention, the patient was encouraged to restore his work and marriage after the symptoms were relieved.