Progress in Research on Post-Traumatic Stress Disorder

In recent years, with the increase of natural disasters, wars, and terrorist incidents, etc., there are more and more researches on post-traumatic stress disorder (PTSD). This paper bases on the definition, pathogenic mechanism and related gene research of post-traumatic stress disorder. Mechanism, reviews the research status of post-traumatic stress disorder to improve people’s understanding of post-traumatic stress disorder, and prospect for future research.

Review of Action Mechanisms of Acupuncture on Post-Traumatic Stress Disorder

Post-traumatic stress disorder(PTSD)is a kind of mental disorder caused by severe traumatic events.It has a high incidence,a serious of impacts on the physical and mental health of patients.Especially in the current situation of COVID-19,the researches on PTSD are particularly important,but the choice of drugs available for PTSD is limited and it is often accompanied by adverse reactions.In the field of acupuncture,there are many clinical research evidences suggested that PTSD is a predominant disease of acupuncture.However,its action mechanisms have not been fully elucidated,so the possible mechanisms of acupuncture in treating PTSD were discussed.

Pushing the frontiers of military medical excellence:updates,progress and future needs

Since its establishment in 2014,Military Medical Research has come a long way in becoming a premier journal for scientific articles from various different specialties,with a special emphasis on topics with military relevance.The field of military medicine may be obscure,and may not be readily encountered by the typical clinician on a day-today basis.This journal aims not only to pursue excellence in military research,but also to keep current with the latest advancements on general medical topics from each and every specialty.This editorial serves to recap and synthesize the existing progress,updates and future needs of military medical excellence,discussing foremostly the unique traits of literature published in this journal,and subsequently presenting the discourse regarding wartime and peacetime medicine,the role of the military in a public health emergency,as well as wound healing and organ regeneration.Special attention has been devoted to military topics to shed light on the effects of Chemical,Biological,Radiological and Explosive warfare,environmental medicine and military psychiatry,topics which rarely have a chance to be discussed elsewhere.The interconnectedness between military combat and soldier physical and mental well-being is intricate,and has been distorted by pandemics such as coronavirus disease 2019(COVID-19).This journal has come a long way since its first article was published,steadily contributing to the existing knowledge pool on general medical topics with a military slant.Only with continuous research and sharing,can we build upon the work of the scientific community,with hopes for the betterment of patient care.

汶川地震极重灾区社区居民创伤后应激障碍发生率及影响因素

目的：调查汶川地震后，极重灾区社区居民创伤后应激障碍发生率及影响因素，为进一步开展灾后心理卫生服务提供依据。方法：采用整群随机抽样的方法，从安县京安小区、什邡红白镇两个临时安置点社区居民2685人中，随机抽取820名社区居民登记人口学背景、受灾状况，并使用PTSD检查量表平民版（PTSD Checklist—Civilian Version，PCL—C）和领悟社会支持量表（Perceived Social Support Scale，PSSS）进行评估，依据DSM-Ⅳ中PTSD的诊断标准确诊PTSD患者。结果：在完成的820份调查评估资料中，785份PCL—C和PSSS问卷有效。男女比例为1：1．41；平均年龄（43±18）岁；26．0％患有躯体疾病，28．4％有地震前饮酒习惯，23．6％有震后饮酒行为。不同年龄居民PSSS总分及2因子分差异均无统计学意义（P〉0．05）。PTSD的临床检出率为12．4％（97／785），女性PTSD发生率高于男性（15．3％vs．8．3％，P=0．003），地震中有曾被掩埋经历者PTSD发生率高于无被掩埋经历者（26．3％vs．11．6％，P=0．018），有丧亲者的FFSD发生率高于无丧亲者（18．7％vs．11．1％，P=0．015）。以PTSD诊断是否成立为因变量，一般资料为自变量进行Logistic回归分析显示：女性（OR=2．070，95％CI：1．274—3．365）、有曾被掩埋经历者（OR=2．806，95％CI：1．249～6．306）、亲人丧失（OR=1．537，95％CI：1．087—2．173）及PSSS评分偏低（OR=0．960，95％CI：0．941～0．979）是PTSD发生的危险因素。结论：在灾后社区重建过程中，临时安置点社区居民存在较高的创伤后应激障碍的发生率，女性、有曾被掩埋经历、亲人丧失及个人感受到的社会支持偏低是PTSD发生的危险因素。

汶川地震极重灾区780名受灾群众心理状况调查

目的了解汶川地震受灾群众的受灾情况及心理状况,为进一步开展心理干预提供依据。方法采用横断面调查方法,对成都市2个临时居住点极重灾区受灾群众登记人口学背景、受灾情况及PTSD(Post-traumatic stress disorder)检查量表平民版(PCL-C)评估,依据DSM-Ⅳ的诊断标准,进行急性应激障碍(ASD)临床检查。结果780名受灾群众完成登记评估。在完成登记的资料中729份有效,其中450份PCL-C有效;男女比例为1:1.31。平均年龄36.73±20.82岁;9.5%患有躯体疾病,9.7%生活需人协助,70.7%被动和没有参加社区活动,9.1%严重心理问题。ASD的发生率为30.9%(139/450),PCL-C≥38分有186(41.3%)例,PCL-C≥45分有100(22.2%)例,PCL-C≥50分者有83(18.4%)例,PCL-C≥45分筛查结果与临床诊断结果一致性检验较好(Kappa=0.780,P=0.033)。ASD组和非ASD组性别构成比差异无统计学意义(P>0.05),ASD组与非ASD组年龄差异有统计学意义(P<0.05)。结论来自地震极重灾区的受灾群众较早出现了心理问题。在生命救助的同时,应该尽早关注他们的心理问题。

加州大学洛杉矶分校创伤后应激障碍反应指数(儿童修订版)的效度和信度检验

目的:检验加州大学洛杉矶分校创伤后应激障碍反应指数(儿童修订版)(UCLA PTSD-RI)在灾后儿童中的效度和信度。方法:选取辽宁省抚顺市受灾地区的6所中小学(4~9年级)学生1593人[年龄8~16岁,平均(11±2)岁],将其随机分为两部分,一部分(n=796)用于探索性因素分析,另一部分(n=797)用于验证性因素分析。使用抑郁-焦虑-压力量表简版(DASS-21)评估效标效度。结果:探索性因素分析显示共有3个因子,累计可解释的方差为50%;验证性因素分析表明三因素结构各项指标拟合良好(χ~2/df=3.87,GFI=0.93,RFI=0.96,CFI=097,NNFI=0.97,IFI=0.97,RMSEA=0.06)。量表的3个维度得分与DASS-21的3个维度得分呈正相关(r=0.52~0.70,均P<0.001)。量表的内部一致性信度和分半信度分别为0.90和0.87。结论:本研究提示,加州大学洛杉矶分校创伤后应激障碍反应指数(儿童修订版)具有良好的效度和信度,可用于灾后儿童创伤后应激障碍的评估。

医疗事故鉴定患者创伤后应激障碍的症状及相关因素分析

目的探讨委托医疗事故鉴定患者创伤后应激障碍(posttraumatic stress disorder,PTSD)症状及相关因素。方法采用创伤后应激障碍清单(PCL-C)、状态-特质焦虑问卷(state-trait anxiety inventory,STAI)、抑郁自评量表(self-rating depression scale,SDS)、艾森克个性问卷(eysenck personality questionnaire,EPQ)对委托医疗事故鉴定154例PTSD的发生率及症状相关性进行评价。结果本研究收回有效问卷151份,以50分作为分界值,PTSD发生率为21.19%(32/151,PTSD组)。鉴定为事故组的PTSD发生率高于无事故组及终止鉴定组(P<0.05),事故组闯入性症状、高警觉性及PCL-C总分均高于其他两组(P<0.05)。PTSD组闯入性症状、高警觉性、回避症状及PCL-C总分均高于非PTSD组(P<0.05);患者中女性较男性有更多的闯入性再体验症状及高警觉性,男性患者更多表现为回避症状(P<0.05)。回归分析显示,焦虑、抑郁状态及神经质是PTSD发生的重要预知因素。结论委托医疗事故鉴定患者PTSD的发生率高,症状明显,对其心理影响大;抑郁、焦虑状态、神经质是PTSD发生的危险因素,需及时干预。

陆航团官兵创伤后应激障碍流行病学调查

目的:研究陆航部队官兵创伤后应激障碍(PTSD)的发病情况。方法:对某陆航团整群抽样,采用美国精神疾病诊断标准(第4版)所提供的创伤后应激量表及创伤后应激障碍检查量表(军人版)进行调查。结果:陆航官兵的PTSD发病率为7.1%,空勤人员的发病率为9.5%,地勤人员的发病率为6.8%。应激源依次为近亲属去世、受到处分、军事行动。PTSD检查量表评分≥42者诊断符合率为71.1%。结论:陆航团PTSD的患病率远高于既往的流行病调查结果(4.86‰),因此有必要进行更大范围的调查。遭遇负性事件在PTSD的发生中起更重要的作用。

电针对创伤后应激障碍大鼠行为学及海马SYN、PSD95表达的影响

Objective: Electroacupuncture (EA) in the treating principle of “soothing the liver and regulating the kidney” was applied to intervion the rats with post-traumatic stress disorder (PTSD), and its effect on anxiety-like behavior, spatial learning and memory ability, and expressions of synaptophysin (SYN) and postsynaptic dense 95 (PSD95) in hippocampus of rats were observed to explore the underlying mechanism.Methods: Twenty-four male SD rats were randomly divided into control group, model group, and EA group, with 8 rats in each group. There was no intervention in the control group. The rest 16 rats were prepared for modeling. The single-prolonged stress & shock (SPS&S) method was used to establish the PTSD models. There was no intervention in the model group after modeling. In the EA group, “Bǎihuì (百会GV20)”“ Shéntíng (神庭GV24)”“Gānshū (肝俞BL18)”“Shènshū (肾俞BL23)” were manipulated with EA stimulation, intensity 1 mA, frequency 2/100 Hz, disperse-dense wave, and treatment was performed once a day, 20 min each time, for a total of 21 days. Open field test, elevated plus maze and Morris water maze tests were used to observe the behavioral differences of rats in each group. Immunohistochemical method was used to observe the differences of positive expressions of proteins SYN and PSD95 in hippocampus.Results: In the open field test, compared with the control group, the total traveling distance, the percentage of the time spent in the central cell and the numbers of the central cells crossing in the model group were all decreased (all P < 0.05). Compared with the model group, these indicators in the EA group were significantly all increased (all P < 0.05). In the elevated plus maze test, compared with the control group, the percentages of open arm staying time and entering times in the model group were both decreased (both P < 0.05). Compared with the model group, these indicators in the EA group were both significantly increased (both P < 0.05). The results of Morris water maze test showed that compared with the control group, the escape latency time and travelled distance of rats in the model group were all increased from day1 to day 4 (all P < 0.05), and the percentage of staying time in the target quadrant was decreased (P < 0.05). Compared with the model group, the escape latency time and travelled distance of EA group were both significantly shortened (both P < 0.05), and the percentage of staying time in the target quadrant was significantly increased (P < 0.05). The immunohistochemical results showed that, compared with the control group, the positive expressions of SYN and PSD95 in the hippocampus of the model group were significantly down-regulated (both P < 0.05). Compared with the model group, the positive expressions of SYN and PSD95 in the hippocampus of the EA group were significantly up-regulated (both P < 0.05).Conclusions: EA in the treating principle of “soothing the liver and regulating the kidney” can effectively relieve anxiety-like behavior and improve spatial learning and memory ability of rats with PTSD, and the mechanism is related to the up-regulation of the expressions of SYN and PSD95 in the hippocampus.