Transcript Document 7373762
意外災害後常見精神疾病
創傷後症候群
(Post-traumatic Stress Disorder)
Common post-disaster psychiatric disorders
• • • •
Post-traumatic stress disorder Depressive disorders
– – –
Major depression Dysthymic disorder Mixed anxiety & depression Panic disorder Generalized anxiety disorder
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Common post-disaster psychiatric problems
• • • • •
Insomnia Substance abuse (alcohol ) Suicide Survivor guilt Domestic violence
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Post-traumatic Stress Disorder
Events
Actual or threatened death or serious injury
Threat to physical integrity
Response
Intense fear, helplessness, or horror
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創傷後症候群的症狀
經常重歷災難經驗
(Re-experience)
迴避與災難相關之人事物
(Avoidance)
對外界事物反應麻木
(Emotional Numbness)
過度覺醒
(Hyperarousal)
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創傷後症候群的症狀
經常重歷災難經驗
(Re-experience)
重複侵入腦海之影像或念頭
(Intrusive recollection)
惡夢連連
(Recurrent nightmare)
解離症狀
(Dissociative flashback)
情緒或生理反應再現 2020/4/30 6
創傷後症候群的症狀
迴避與災難相關之人事物
(Avoidance)
迴避討論或感受 迴避場合與人物 無法回憶創傷事件過程 2020/4/30 7
創傷後症候群的症狀
對外界事物反應麻木
(Emotional Numbness)
參與重要活動的興趣明顯降低 與他人疏離 情感表達鈍化
Sense of forshortened future
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創傷後症候群的症狀
過度覺醒
(Hyperarousal)
失眠 無法控制的憤怒 無法專心
Hypervigilance
強烈驚嚇反應 2020/4/30 9
Post-traumatic Stress Disorder
類型
(Types)
急性壓力障礙
(Acute Stress Disorder)
急性創傷後症候群
(Acute PTSD)
慢性創傷後症候群
(Chronic PTSD)
晚發型
(Delayed onset)
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Risk Factors of PTSD
•
Demographic correlates
–
Sex
–
Age
– –
Education Income
– – –
Marital status Region Urbanity
• •
Trauma related
–
Type of trauma
–
Severity of trauma Biological correlates
–
Genetics
– –
Personality Psychophysiology
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創傷後症候群的治療
藥物治療
SSRIs
或
SNRI
抗鬱劑
Nefazodone, Trazodone
三環抗鬱劑
Benzodiazepines
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創傷後症候群的治療
非藥物治療
焦慮管理
(Anxiety Management)
Relaxation training Breathing training Positive thinking Assertive training Though stopping ANXIETY
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創傷後症候群的治療
非藥物治療
精神衛教
(Psychoeducation)
認知治療
(Cognitive therapy)
遊戲治療
(Play therapy)
暴露治療
(Exposure therapy)
Imaginal exposure In vivo exposure
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MHRP at Puli town
• 埔里基督教醫院 黃蔚院長 李智貴醫師 • 劉永昌醫師 台中靜和醫院 柯毅文院長 施義賢醫師 • 成功大學附設醫院 陳純誠主任 楊延光醫師 葉宗烈醫師 陳信昭醫師 2020/4/30 15
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THANK YOU !
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MHRP at Puli town
• 埔里基督教醫院 黃蔚院長 李智貴醫師 • 劉永昌醫師 台中靜和醫院 柯毅文院長 施義賢醫師 • 成功大學附設醫院 陳純誠主任 楊延光醫師 葉宗烈醫師 陳信昭醫師 2020/4/30 17
Mental Health Relief Programme
• Debriefing group for hospital staffs • Screening in community • Establishment of psychiatric services in community and shelter-camp • Home visit and treatment for severe • psychiatric morbidity 2020/4/30 18
Subjects and Methods
• 13114, 18 years old, surveyed • Mean age = 41 16 • 53.3% female, 46.7% male 2020/4/30 19
Subjects and Methods
• Damage of house – complete destroyed – partial destroyed • Injury of relatives – death – serious injured – mild injured 16.4% 35.1% 6.4% 2.2% 9.6% 2020/4/30 20
Subjects and Methods
• Financial status – Marked difficulty – Moderate difficulty – Mild difficulty 10.8% 17.4% 46.6% 2020/4/30 21
Subjects and Methods
• Death witness • Personality traits – Nervous trait – Obsessive trait – Inhibition trait 16.0% 38.0% 28.5% 16.7% 要求完美 2020/4/30 22
Assessment Instruments
• Psychiatric Morbidity – CHQ-12 • Symptom Check List for – PTSD symptoms – Depressed mood – Guilt feeling – Suicide idea 2020/4/30 23
Outcomes
• Post-traumatic Stress Disorder • Psychiatric Morbidity • Depression • Suicide idea 2020/4/30 24
Anxiety symptoms
% 30 25 26.7
24.1
20 15 10 5 19.5
17.9
16.2
14.7
12.3
10.1
0
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Insomnia Emotional distressed Excessive worry Nervousness Headache Dizziness Chest tightness Palpitation Tremour
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Depression symptoms
% 18 16 14 12 10 8 6 4 2 0 15.7
6.1
8.9
8.7
2.6
1.3
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Depressed mood Hopelessness Lack of confidence Guilt feeling Thought of death Suicide idea
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Post-traumatic stress symptoms 2020/4/30
% 60 50 40 30 20 10 0 52.8
Re-experience 5.9
Avoidance
According to DSM-IV
31 Hyperarousal
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Cross-section prevalence (6-month)
• • •
Post-traumatic Stress Syndromes Three dimension syndrome
593 ( 4.5 %)
Any two dimension syndrome
2596 (19.9%) Re-experience + Avoidance Re-experience + Hyperarousal 122 2445 ( 0.9 %) (18.7 %) Avoidance + Hyperarousal 29 ( 0.2 %)
Any one dimension syndrome
Re-experience Avoidance 3731 29 Hyperarousal 985 4745 (36.3%) ( 6.4 %) ( 0.2%) ( 7.5%) 2020/4/30 28
• • •
Cross-section prevalence (6 month)
Suicide idea 386 (2.9 %) Psychiatric morbidity 0-2 3-4 9648 1703 (73.6 %) (13.0 %) 5-6
7 921 842 ( 7.0 %) ( 6.4 %) Probable psychiatric case (CHQ
4) 2457 (18.8%)
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Psychiatric Disorder among Victims (N=149)
• • • • •
Major depression
– –
First episode Recurrent Dysthymic disorder Panic disorder PTSD GAD 39 (26.2%) 13 ( 8.7%) 20 (13.4%) 7 ( 4.7%) 50 (33.6%) 17 (11.4)
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Psychiatric Disorder among subjects with suicidal ideation (N = 71)
• • • •
All psychiatric disorders Major depression
– –
First episode Recurrent Dysthymic disorder PTSD 55 (77.5%) 22 (30.9%) 9 ( 12.7%) 18 (25.4%) 28 (39.4%)
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2020/4/30 Demography and occurrence of PTSD, suicide idea, and psychiatric morbidity Table 1. Associations between psychosocial factors and psychiatric case, PTSD, and suicide idea (N=13114) Probable Psychiatric caseness OR (95% CI) PTSD OR (95% CI) Suicide idea OR (95% CI) Stage of visit 4th month 3rd month 2nd month Gender Male Female Age group Young (18 – 29) Middle (30 – 49) Old ( 50) 1.0
2.63(2.27 - 3.04) 5.71(4.88 - 6.69) 1.0
1.79(1.61 - 1.99) 1.0
2.00(1.74 - 2.30) 2.35(2.03 - 2.72) 1.0
1.88(1.50 - 2.37) 4.08(3.20 - 5.21) 1.0
1.21(1.02 - 1.43) 1.0
1.51(1.23 - 1.86) 1.18(0.93 - 1.50) 1.0
1.50(1.15 - 1.95) 3.11(2.34 - 4.14) 1.0
1.46(1.18 - 1.79) 1.0
1.22(0.95 - 1.58) 1.16(0.88 - 1.53) 32
2020/4/30 Damage index and occurrence of PTSD, suicide idea, and psychiatric morbidity Destruction of house No damage Mildly damaged Partially destroyed Completely destroyed Injury of relative No injury Mildly injured Seriously injured Dead Financial strain No difficulty) Mild difficulty Moderate difficulty Marked difficulty Probable Psychiatric caseness OR (95% CI) PTSD OR (95% CI) Suicide idea OR (95% CI) 1.0
1.21(0.99 - 1.48) 2.57(2.13 - 3.11) 3.36(2.74 - 4.10) 1.0
1.28(0.91 - 1.81) 2.49(1.80 - 3.43) 2.91(2.07 - 4.10) 1.0
0.87(0.61 - 1.26) 1.46(1.04 - 2.05) 1.94(1.35 - 2.79) 1.0
1.60(1.36 - 1.87) 3.35(2.59 - 4.33) 2.51(2.12 - 2.97) 1.0
2.33(1.85 - 2.94) 2.82(1.97 - 4.24) 2.78(2.15 - 3.60) 1.0
1.58(1.16 - 2.16) 1.99(1.15 - 3.46) 2.70(1.99 - 3.66) 1.0
1.75(1.49 - 2.05) 3.01(2.53 - 3.58) 6.02(5.04 - 7.19) 1.0
2.55(1.88 - 3.45) 3.79(2.74 - 5.25) 7.80(5.66 -10.74) 1.0
1.87(1.33 - 2.64) 2.53(1.73 - 3.70) 6.55(4.58 - 9.36) 33
Death witness, personality and occurrence of PTSD, suicide idea, and psychiatric morbidity 2020/4/30 Death witness No Yes Nervous trait No Yes Perfectionism trait No Yes Inhibition trait No Yes Probable Psychiatric caseness OR (95% CI) PTSD OR (95% CI) Suicide idea OR (95% CI) 1.0
2.56(2.28 - 2.88) 1.0
5.69(5.08 - 6.38) 1.0
1.89(1.70 - 2.10) 1.0
2.72(2.27 - 3.25) 1.0
2.50(2.00 - 3.11) 1.0
6.58(5.37 - 8.06) 1.0
4.63(3.68 - 5.83) 1.0
2.91(2.46 - 3.44) 1.0
1.99(1.62 - 2.44) 2.02(1.80 - 2.28) 4.36(3.67 - 5.17) 2.97(2.04 - 3.68) 34
Table 4 Association models of post-earthquake suicide ideation, post-traumatic syndrome and probable psychiatric case (N=12499) Suicidal Ideation (I) Suicidal Ideation (II) Probable PTSD case a Probable Psychiatric Case 1.37 (1.09 – 1.72) 1.86 (1.69 – 1.06) 1.66 (1.50 – 1.84) Gender Age 30 – 49 50 Severe Destruction of House Serious Injury Severe Financial Difficulty Witness of Death 1.33 (1.05 – 1.68) 1.29 (1.03 – 1.62) 1.41 (1.04 – 1.91) 1.98 (1.59 – 2.46) 1.74 (1.36 – 2.23) 1.52 (1.35 – 1.72) 2.67 (2.35 – 3.02) 1.70 (1.54 – 1.86) 1.46 (1.26 – 1.70) 1.66 (1.50 – 1.83) 1.67 (1.48 – 1.88) 1.44 (1.26 – 1.64) 2.09 (1.82 – 2.39) 1.80 (1.63 – 2.00) 1.57 (1.35 – 1.84) 1.97 (1.78 – 2.18) 1.87 (1.65 – 2.12) Nervous trait Introverted Trait Obsessive Trait Depressed Mood Guilt Feeling Hopelessness CHQ score 4 3 dimensions of PTSD 2 dimensions of PTSD 1 dimension of PTSD 1.55 (1.21 – 1.99) 1.70 (1.28 – 2.28) 4.44 (3.46 – 5.69) 2.90 (2.16 – 3.91) 1.75 (1.27 – 2.41) 5.91 (3.47 – 10.06) 3.71 (2.31 – 5.95) 1.89 (1.19 – 3.01) 3.16 (2.47 – 4.04) 2.27 (1.80 – 2.85) 3.92 (3.56 – 4.33) 1.54 (1.38 – 1.73) 1.12 (1.02 – 1.25) of post-traumatic stress syndrome 3.70 (3.34 – 4.10) 1.40 (1.24 – 1.58) a: Subjects with 3 dimensions + 2 dimensions -2log LR Model Chi-square Degree of Freedom 3277.6
912.0
9 < 0.0001
3277.6
327.3
7 < 0.0001
13794.8
2340.2
10 < 0.0001
11997.1
1911.0
9 < 0.0001
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CONCLUSIONS
• Depression and PTSD are major psychiatric disorders • Measures to reduce financial strain of victims facilitate process of psychological rehabilitation • Neurotic personality traits are vulnerability • Out-reach team is important for efficiently conveying psychiatric care 2020/4/30 36
2020/4/30
THANK YOU !
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